Influence of N-acetyl-L-cysteine on biofilm formation by Pseudomonas aeruginosa chronic wound isolates in vitro
Alex Cazzaniga, BS; Michael Shelling; John Heaphy; Carlos Ricotti, Jr., MD; Patricia Mertz, BA; and Stephen Davis, BS;
University of Miami Department of Dermatology, Miami, Fla.
       Pseudomonas aeruginosa infections are a major threat to patients with chronic wounds and burns. Our laboratory has shown that clinical isolates form biofilms in vitro and in vivo. Once biofilms are established, phagocytosis and diffusion of antibiotics are impaired; thus, facilitating the colonization and persistent infections. N-acetyl-L-cysteine (NAC) is a non-antibiotic drug that has antimicrobial properties. It is a mucolytic agent that disrupts disulfide bonds and reduces the viscosity of secretions. This study examined the efficacy of NAC on preventing biofilm formation of Pseudomonas aeruginosa chronic wound isolates in vitro. Bacterial suspensions in Tryptic soy broth (TSB) were grown in polystyrene wells and incubated. At 24 hours, the bacteria suspensions were removed and discarded. Wells were gently washed with PBS, air-dried, and heat fixed. Wells were stained with Hucker’s crystal violet solution to quantitate biofilm formation. Excess stain was washed off with PBS and Tween-80 was added to wells. Stained biofilms were removed by sonication and their optical density quantified. They all developed biofilms of varying intensity with unique dose-related responses to the experimental concentrations of NAC. At 4 mg/mL, biofilm formation was completely prevented in all strains examined. This study demonstrated that NAC is effective in preventing biofilm formation of wild type Pseudomonas aeruginosa wound strains.

References
1. Olofsson AC, Hermansson M, Elwing H. N-acetyl-L-cysteine affects growth, extracellular polysaccharide production, and bacterial biofilm formation on solid surfaces. Appl Environ Microbiol. 2003;Aug;69(8):4814–4822.
2. Harrison-Balestra, Cazzaniga, Davis, Mertz. A wound-isolated Pseudomonas aeruginosa grows a biofilm in vitro within 10 hours and is visualized by light microscopy. Dermatol Surg. 2003 Jun;29(6):631–635.


Prediction of wound healing outcome in 99 patients using skin perfusion pressure and transcutaneous PO2
Takkin Lo, MD, MPH, CHT; Richard Sample, RCP, RRT, CHT; Renee Prins, BS; Johnny Mao, BS; Jeanette Rylander, BS; Sarah Taylor, BS; James Anholm, MD; David Christenson, RCP, RRT, CHT; Patrick Moore, MBA, RCP, RRT; Philip Gold, MD; Loma Linda University Medical Center, Loma Linda, Calif.
        Purpose: Prediction of wound healing outcome has been done using transcutaneous oxygen partial pressure (tcPO2) for many years. Skin Perfusion Pressure (SPP) provides a recent alternative that is done with a specially designed laser Doppler sensor for blood flow detection. We studied the efficacy and outcome of chronic extremity wounds using SPP compared to tcPO2.
       Methods: A prospective, comparative study was conducted over a 4-year period at our Wound Treatment Center. Concurrent room-air measurements on corresponding sites were done with SPP and tcPO2 on 99 patients (mean age 63.1 years) with chronic extremity wounds. SPP and tcPO2 values x30mmHg were used to predict a positive outcome, as suggested by the majority of wound literature. Follow-up was conducted at either 6 or 12 months.
       Results: In our study, 88 of the 99 patients (89%) had wound healing. SPP correctly predicted healing in 81 of the 88 patients (92%) versus tcPO2 that predicted healing in 59 of the 88 patients (67%) [p < 0.01 (Pearson Chi-square)].
Conclusion: This study-in-progress of 99 patients shows SPP to have a significantly higher accuracy than tcPO2 in predicting healing outcome of chronic extremity wounds.


In vitro evaluation of biofilm development on tissue engineered skin
Carlos A. Charles, MD; Carlos A. Ricotti, MD; Stephen C. Davis; University of Miami School of Medicine, Department of Dermatology and Cutaneous Surgery, Miami, Fla.; and Robert S. Kirsner, MD, University of Miami School of Medicine, Department of Dermatology and Cutaneous Surgery; University of Miami School of Medicine, Department of Epidemiology and Public Health, Miami, Fla.; and Veterans Administration Medical Center, Miami, Fla.
       Bacteria exist in various forms, including planktonic, or free-floating, or as biofilms. Biofilms, adherent aggregates of microcolonies of bacteria, exhibit an altered phenotype regarding growth rate and gene transcription. They are associated with increased resistance to antibiotic therapy and account for various microbial infections. The development of models for biofilm growth is important to better understand potential treatments. The objective of this study was to determine if biofilm formation occurs on human skin equivalents (HSE) and to establish a biofilm skin infection model.
       Wounded HSE was inoculated with 1.0 x 105 CFU per gram of Pseudomonas aeruginosa or Staphylococcus aureus. Samples of the HSE were obtained at 3, 5, 7, 10, and 24 hours and processed for histologic analysis with light and epifluorescent microscopy. Adherent microcolonies of bacteria were observed starting at 5 hours by H&E staining. Epifluorescent microscopy using calcofluor white revealed the extra-polymeric matrix component of the biofilm. Visualization of antimicrobial peptide human _ defensin-2 expression by HSE during biofilm formation is underway. We demonstrate a model for development of biofilm growth on human skin. This knowledge will help enable the study of biofilms on skin and wounds as well as within HSE and their effect on healing.
       *Product Notation: Apligraf, ® Organogenesis Inc., Canton, MA, USA

References
1. Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev. 2002 Apr;15(2):167–193.
2. Harrison-Balestra C, Cazzaniga AL, Davis SC, Mertz PM. A wound-isolated Pseudomonas aeruginosa grows a biofilm in vitro within 10 hours and is visualized by light microscopy. Dermatol Surg. 2003; 29: 631–635.
3. Schmid P, Grenet O, Medina J, Chibout SD, Osborne C, Cox DA. An intrinsic antibiotic mechanism in wounds and tissue-engineered skin. J Invest Dermatol. 2001;116:471–472.
4. Wilkins LM, Watson SR, Prosky SJ, Meunier SF, Parenteau NL. Development of bilayered living skin construct for clinical application. Biotech Bioengineering. 1994;43:747–756.
5. Muhart M, McFalls S, Kirsner RS, Elgart GW, Kerdel F, Sabolinski ML, Hardin-Young J, Eaglstein WH. Behavior of tissue-engineered skin: a comparison of a living skin equivalent, autograft, and occlusive dressing in human donor sites. Arch Dermatol. 1999;135(8):913–918.
6. Brem H, Balledux J, Sukkarieh T, Carson P, Falanga V. Healing of venous ulcers of long duration with a bilayered living skin substitute: results from a general surgery and dermatology department. Dermatol Surg. 2001; 27: 915–919.


The size of the problem of lymphedema
Peter J. Franks, PhD; Christine J Moffatt, RN, PhD; Debra C. Doherty RN; Anne F. Williams, RN; Centre for Research & Implementation of Clinical Practice, Thames Valley University, London, UK; Caroline M.A. Badger, RN PhD, Lymphoedema Service, St. George’s Hospital Medical School, London, UK; Eunice Jeffs, RN, Centre for Research & Implementation of Clinical Practice, Thames Valley University, London, UK; Nick Bosanquet, MA, Imperial College, London, UK; Peter S. Mortimer, MD, FRCP, Department of Physiological Medicine, St. George’s Hospital Medical School, London, UK
       Lymphedema is a chronic condition characterized by swelling, usually of one or more limbs, but in some cases trunk, genitalia or face. Debilitating infections result from disturbed immunosurveillance. It is acknowledged as a serious complication of cancer treatment, but may affect many other patients. This study aimed to identify all patients with chronic edema > 3 months duration within a specific geographical area of London, UK; to understand how lymphedema affects the patient and its impact on health and social services.
       Patients were identified through health professionals delivering care to a population of southwest London. All community staff, hospital wards and specific out-patient services, residential and nursing homes and lymphedema specialists were contacted to provide information. Interviews and clinical examination undertaken in a sample of patients who were identified. to validate the presence of lymphoedema and obtain more detailed information on impact of the disease on patients and health services.
       In total, 823 patients were identified from a population of 619,000 (1.33 per 1,000) with prevalence rising to 0.5% in the > 65 year olds. Only 64% had received any form of lymphedema treatment. Of the 259 interviewed, one quarter had taken time off from work because of their swelling with 8% having given up work completely. In all, 37% had experienced acute infection (cellulitis) since onset of swelling and 10% had experienced a medical admission for their swelling (mean inpatient stay 11.7 days). Over the previous year 28% had suffered cellulitis and 7% were admitted.
       Lymphedema is much more common than generally realised with the majority not related to cancer. Many patients receive sub-optimal or no treatment. Complications such as infection create a significant cost implication to health services.

Quality of life in patients suffering from lymphedema
Peter J. Franks, PhD; Christine J. Moffatt, RN, PhD; Debra C. Doherty, RN; Anne F. Williams, RN; Centre for Research & Implementation of Clinical Practice, Thames Valley University, London, UK; Caroline M.A. Badger, RN PhD, Lymphoedema Service, St. George’s Hospital Medical School, London, UK; Eunice Jeffs, RN, Centre for Research & Implementation of Clinical Practice, Thames Valley University, London, UK; Nick Bosanquet, MA, Imperial College, London, UK; Peter S. Mortimer, MD, FRCP, Department of Physiological Medicine, St. George’s Hospital Medical School, London, UK
       Lymphedema is a chronic condition characterised by swelling, usually of one or more limbs, but in some cases trunk, genitalia or face. While there is some evidence of the impact of the disease on specific groups, there is a lack of evidence on how it affects the overall population of patients. As part of an epidemiology study in London, UK, health related quality of life (HRQoL) was examined in patients suffering from lymphedema.
       Of the 248 interviewed (184, 75% women), 46% had experienced swelling for longer than five years. Results from the SF-36 showed significantly poorer HRQoL in patients with lymphoedema compared with normative data, for physical functioning (difference[d]=21.5, P<0.001), role physical (d=27.1, P <0.001), pain (d=8.8, p<0.001), social functioning (d=23.1, P <0.001), role emotional (d=25.5, P <0.001) and vitality (d=5.2, P = 0.007). Pain and discomfort from the swelling was experienced by half of all patients, which was only fully relieved by analgesia in 16% and only partially relieved in 64%. Descriptors of the McGill Short form pain questionnaire most frequently cited were aching (36%) and heaviness (33%).
       Patients with lymphedema experience substantial deficits in HRQoL, including a substantial proportion with pain. Effective management must address these deficits to improve daily functioning of patients with this condition.

An increased incidence of depression in patients with venous leg ulcerations: subgroup analysis from a recent multi-center clinical trial
Mark Beuger, MD, Gannon University and Warren Research Institute; Thomas E. Serena MD, FACS, Gannon University and Penn North Centers for Advanced Wound Care representing the investigators of the Human Genome Sciences WHO-4 Clinical Trial. Tamara Orr, PA-S, Gannon University
       Background: In the general population the one year prevalence rates for mood disorders in adults over 55, is 4.4%. Recent advances in psychoneuroimmunology have linked depression with delayed wound healing. A large cohort of patients with chronic wounds might, therefore, be expected to have an increased incidence of depression. In addition, only one-third of patients with depression receive pharmacologic treatment.
       Methods: We analyzed the data from the recently completed Human Genome Sciences phase 2B clinical trial in which the growth factor, repifermin, was evaluated in patients with chronic venous leg ulcerations. In this subgroup-analysis, we looked at the number of patients enrolled in the study who were taking psychotropic medication for depression, anxiety or both.
       Results: 39 out of 352 patients, reported taking psychotropic medication for depression (30), anxiety (7) or both (2), totaling 51 prescriptions. The overall prevalence of patients receiving treatment for a mood disorder was 8.5%.
       Conclusion: There was a significant (nearly two-fold) increase in the prevalence of depression in this population. Further study is needed to clarify the extent of depression in this population and the potential role of psychiatric intervention as an adjunct in the treatment of chronic wounds.

References
1. Mental Health: A Report of the Surgeon General, Government Printing Office, 1999 Report.
2. Cole-King A, Harding KG. Psychological factors and delayed healing in chronic wounds. Psychosom Med. 2001;Mar-Apr;63(2):216–220.
3. Franks PJ, Moffatt CJ. Health related quality of life in patients with venous ulceration: use of the Nottingham health profile. Qual Life Res. 2001;10(8):693–700.
4. Kiecolt-Glaser JK, McGuire L, Robles TF, Glaser R. Emotions, morbidity, and mortality: new perspectives from psychoneuroimmunology. Annu Rev Psychol. 2002;53:83–107.
5. Marucha PT, Kiecolt-Glaser JK, Favagehi M : Mucosal wound healing is impaired by examination stress. Psychosom Med. 1998;60(3):362–365.
6. Padgett DA, Marucha PT, Sheridan JF. Restraint stress slows cutaneous wound healing in mice. Brain, Behavior, and Immunity. 1998;12:64–73.
7. Padgett DA, Glaser R How stress influences the immune response. Trends in Immunology. 2003;24(8):444–448.
8. Yang EV, Bane CM, MacCallum RC, Kiecolt-Glaser JK, Malarkey WB, Glaser R. Stress-related modulation of matrix metalloproteinase expression. J Neuroimmunol. 2002;Dec;133 (1-2):144–150.

The effect of a topical oxygen emulsion on granulation tissue formation in second-degree burn wound healing
Jie Li, MD, PhD, University of Miami, Miami, FL; Yan-Ping Zhang, PhD, University of Miami, Miami, FL; Linjian Zhu, MS, University of Miami, Miami, FL; Patricia M. Mertz, BS, University of Miami, Miami, FL; Alejandro L. Cazzaniga, BS, University of Miami, Miami, FL; Carlos Ricotti, MD, University of Miami, Miami, FL; Paul Zalesky, PhD, TherOx Inc., Irvine, CA; Li-Chien Hsu, PhD, TherOx Inc., Irvine, CA; Jeff Creech, PhD, TherOx Inc., Irvine, CA; William H. Eaglstein, MD, University of Miami, Miami, FL; Stephen C. Davis, BS, University of Miami, Miami, FL
       A porcine model of second-degree burn wound was used to evaluate the effect of a newly developed topical oxygen emulsion (TOE) on collagen deposition and angiogenesis during wound repair. The burn wounds were treated with air exposure, vehicle control or TOE (which contains super-saturated oxygen). Wound samples from 6 pigs were collected at days 0, 1, 4, 7, 10, 14 and 21 after wounding. Semi-quantitative RT-PCR (Reverse Transcription and Polymerase Chain Reaction) and immunofluorescent staining were performed to examine mRNA and protein expression levels for type I and type III collagens and vascular endothelial growth factor (VEGF). RT-PCR analysis showed that the mRNA expressions of type I and type III collagens and VEGF were increased in all three groups during wound healing, while significant higher expressions of type III collagen and VEGF were observed in TOE treated wounds. The data obtained from immunofluorescent staining is consistent with the results from RT-PCR analysis. The study suggests that sustained high level of oxygen release by TOE may promote the process of wound repair through the mechanism of increased expression of type I and type III collagens and VEGF, which is critical in granulation tissue formation during wound healing.


Studies of growth factor therapy for acute wound healing in the human forearm biopsy model
Thomas E. Serena MD, FACS and Vincent W. Li MD, on behalf of the Wound Healing Cooperative Group (WHCG), and Kevin Briceland PA-S Gannon University; Kate Eckert PA-S Gannon University, Sheila Payne PA-S Gannon University, William W. Li MD, The Angiogenesis Foundation
       Background: Clinical trials have demonstrated the efficacy of topical rhPDGF-BB in chronic wounds, however its role in acute wound healing is not established. The Wound Healing Cooperative Group (WHCG) utilized a human forearm biopsy model to evaluate the clinical and biological effects of rhPDGF-BB growth factor therapy in the setting of the acute wound.
       Methods: We developed a human model for acute wound healing based on a previous report by Cohen and Eaglstein. A randomized, double-blinded pilot study enrolled 20 normal healthy volunteers who underwent four 6mm biopsies of the flexor surface of both forearms. Biopsy sites were randomly assigned to a control arm (daily bacitracin) or to one of three treatment arms: i) rhPDGF-BB 0.01% gel (Q.D.), ii) rhPDGF-BB (Q.O.D.), iii) rhPDGF-BB (Q.D. x 7 days followed by bacitracin alone daily). The wounds were examined, measured and photographed daily until complete healing was achieved. Rates of healing and time-to-complete closure were measured. Biopsies were taken for gene chip analysis.
       Results: Topical rhPDGF-BB accelerates normal healing rates in the human forearm biopsy model. The growth factor is well tolerated and no adverse events were noted. RhPDGF-BB treated wounds exhibited morphological changes compared to bacitracin. Differences in arm dominance were also noted. A larger scale study is being planned and data will be presented.
       Conclusion: The human forearm biopsy model can be used for the study of growth factor therapy in acute wounds, including clinical and molecular analyses. Recombinant human PDGF-BB is safe and exhibits efficacy in healing acute wounds, as well as chronic wounds.

References
1. Cohen Mark, Eaglstein W. Recombinant human platelet-derived growth factor gel speeds healing of acute full-thickness punch biopsy wounds. JAM Acad Dermatol. 2001:857–862.
2. Robeson MC. The role of growth factors in the healing of chronic wounds. Wound Rep Reg. 1997;5:12–17
3. Embril, J, et al. Recombinant human platelet-derived growth factor-BB (Becaplermin) for healing chronic lower extremity diabetic ulcers: an open-label Clinical evaluation of efficacy. Wound Rep Reg. 2000;8:162–168.
4. Rees RS, Robson MC Smiell JM et al. Becaplermin gel in the treatment of pressure ulcers: a phase II randomized, double blind, placebo-controlled study. Wound Rep Reg.1999;7:141–147.
5. Smiell JM, Wieman TJ, Steed DL, et al. Efficacy and safety of becaplermin (recombinant human platelet-derived growth factor-BB) in patients with nonhealing, lower-extremity, diabetic ulcers: a combined analysis of four randomized studies. Wound Rep Reg. 1999;7:335–346.
6. Steed DL, The Diabetic Ulcer Study Group. Clinical evaluation of recombinant human platelet-derived growth factor for the treatment of lower extremity diabetic ulcers. J Vasc Surg. 1995;21:71–81.
7. Wieman TJ, Smiell JM, Su Y. Efficacy and safety of a topical gel formulation of recombinant human platelet-derived growth factor-BB (becaplermin) in patients with chronic neuropathic diabetic ulcers. A phase III randomized placebo-controlled double-blind study. Diabetes Care. 1998;21:822–827.
8. Shackelford D, Fackler E, Hoffman M, Atkinson S. Use of topical recombinant human platelet derived growth factor BB in abdominal wound separation. Am Journal Obstet Gynecol. 2002;186:701–704.


Wound healing outcomes for 31 patients with diabetic foot wounds: using negative pressure therapy
Laura Teague, RN, MN, ACNP; Elizabeth Newbatt, DCh.; Dorit Zschape, DCh; Allison Rankine, RN, ET; Timothy Daniels, MD, FRCSC; Melinda Musgrave, MD, PhD, FRCSC; James Mahoney, MD, FRCSC, St. Michael’s Hospital, Toronto, Ontario, Canada
       Even with best practices, healing outcomes for patients with diabetic foot ulcers continue to challenge health care providers.5,9 Wound healing in the context of diabetes mellitus is complex and multifactoral.
       At our tertiary acute care, inner city hospital, significant numbers of patients present with acute, limb threatening foot wounds (due to infection and/or ischemia) and with chronic, neuropathic wounds. Negative pressure therapy is often utilized to facilitate wound closure. Controlled and uncontrolled trials have demonstrated efficacy in enhancing dermal perfusion, modulating soft tissue repair with mechanical stress, wound contraction, salvaging tissue, controlling exudates and reducing wound edema.2,3,5-7,10,11
       We present 31 consecutive patients with diabetic foot wounds who were treated with negative pressure therapy during their tenure at our facility. On admission to hospital, the majority of the patients were at high risk for major amputation (Grade IIIB or worse).3
       Data were analyzed, based on treatment and consisted of three groups: all patients, negative therapy alone, and negative therapy plus adjuvant therapy. Statistical analyses consisted of one way repeated ANOVA with post hoc testing (where appropriate) on measures of wound volume over time. For the purposes of this study, wounds were deemed clinically closed when the wound was less that 1cm3 and simpler moist wound healing therapies were possible.
       Statistical improvement was noted at 4 weeks and at final week in both groups; 83% of the patients treated were clinically closed at 11.8 + 6.2 weeks (P <0.01). We have demonstrated efficacy of topical negative pressure in the diabetic foot wound population. This retrospective review supports the need for adequately powered randomized controlled studies to examine cost-effectiveness, limb salvage and quality of life.

References
1. Argenta LC, Morykwas MJ. Vacuum-assisted closure: A new method for wound control and treatment. Clinical experience. Annals of Plastic Surgery. 1997;38(6):563–577.
2. Armstrong DG, Lavery LA, Abu-Rumman P, et al. Outcomes of subatmospheric pressure dressing therapy on wounds of the diabetic foot. Ostomy Wound Management. 2002;48(4):64–68.
3. Armstrong DG, Lavery LA, Harkness LB. Validation of a diabetic wound classification system. Diabetes Care. 1998;21:855–859.
4. Banwell PE, Teot L. Topical negative pressure (TNP): the evolution of a novel wound therapy. Journal of Wound Care. 2003;12(1):22–28.
5. Banwell PI. Negative pressure therapy in wound care. Journal of Wound Care. 1999;8(2):79–84.
6. Margolis DJ, Kantor J, Berlin JA. Healing of diabetic neuropathic foot ulcers receiving standard treatment. A meta-analysis. Diabetes Care. 1999;22(5):692–695.
7. McCallon SK, Knight CA, Valiulus JP, e tal. Vacuum-assisted closure versus saline-moistened gauze in the healing of postoperative diabetic foot wounds. Ostomy Wound Management. 2000;46(8):28–32,34.
8. Morykwas MJ, Argenta LC, SheltonBrown EI, McGuirt, W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Annals of Plastic Surgery. 1997;38(60):553–562.
9. Mullner T, Mrkonjic L, Kwasny O, Vecsei V.(1997). The use of negative pressure to promote the healing of tissue defects: a clinical trial using the vacuum sealing technique. British Journal of Plastic Surgery. 1997;50:194–1999.
10. Sibbald RG, Williamson D, Orsted H, Campbell K, Keast D, Krasner D, Sibbald D. Preparing the wound bed: debridement, bacterial balance and moisture balance. Ostomy Wound Management. 2000;46(11):14–35.
11. Schneider A., Morykwas MJ, Argenta LC.(1998). A new and reliable method of securing skin grafts to the difficult recipient bed. Plastic and Reconstructive Surgery. 1998;102(4):1195–1198.
12. Sposato G, Molea G, Di Caprio G, Scioli M, La Rusca I, Ziccardi P. (2001) Ambulant vacuum-assisted closure of skin-graft dressing in the lower limbs using a portable mini-VAC device. British Journal of Plastic Surgery. 2001;54(3):235–237.



Outcomes associated with using a formulated 2-octylcyanoacrylate topical bandage* on skin tears in elderly institutionalized adults
Catherine T. Milne, APRN, MSN, CS, CWOCN, ANP; Lisa Q. Corbett APRN, MSN, CS, CWOCN; Connecticut Clinical Nursing Associates, LLC, Bristol, Connecticut
       Introduction: Skin tears are a common phenomenon in elderly institutionalized adults (EIAs). Incidence ranges from 0.92 to 2.5 per person/year.1 Presenting as a complete avulsion or as a jagged L or crescent shaped flap, there is little supportive literature regarding optimal treatment with many regimens reported 1- 5.
       Methods: Twenty EIAs (mean 82.5 +/-11.2 years) with Payne-Weber Category II and III skin tears less than 8 hours duration were prospectively enrolled. A formulated 2-octylcyanoacrylate topical bandage* (2-OTB) was applied. Subjects were followed weekly until healed.
       Results: Complete healing occurred with one application of 2-OTB in 90% (18/20) of study subjects. 5% (1) reported transient mild pain (less than 15 seconds). 90% (n=19) reported no pain. There were no incidents of cellulitis/infection. Shower/bathing routines were not interrupted. Cost averaged less than $1.00/application. Clinician time averaged 1.5 minutes per application. Clinicians reported high satisfaction as repeated dressing changes were eliminated.
       Conclusion: 2-OTB provides a cost-effective, minimally invasive approach to the treatment of skin tears for EIAs with pain rarely reported and no adverse events. Randomized comparative studies are indicated.

       * Band-Aid® Brand Liquid Bandage (Johnson and Johnson, Consumer Products Division, Skillman, NJ)

References
1. Selden, S., Cowell, B., Fenno, J. Skin tears: recognizing and treating this growing problem. Skin and Aging. 2002;10(11):55–60.
2. Meuleneire F. Using a soft silicone-coated net dressing to manage skin tears. Journal of Wound Care. 2002;11(10):365–369.
3. Thomas DR, Goode PS, LaMaster K, Tennyson T, Parnell LK. A comparison of an opaque foam dressing versus a transparent film dressing in the management of skin tears in institutionalized subjects. Ostomy Wound Management. 1999;45(8):6.
4. Edwards H, Gaskill D, Nash R. Treating skin tears in nursing home residents: a pilot study comparing four types of dressings. International Journal of Nursing Practice. 1998;4(1):25–32.
5. McGough-Csarny J, Kopac CA. Skin tears in institutionalized elderly: an epidemiological study. Ostomy Wound Management.1998 44(3A Suppl):14S–24S.

An in vitro comparison of the effectiveness of silver and cadexomer iodine-based wound dressings on controlling growth of resistant microorganisms
Teresa Conner-Kerr, PhD, PT, CWS, CLT, Elon University, Elon, NC; P. Karen Sullivan, PhD, MT(ASCP), SM(ASCP); Lee Shuping, SPT; Nicole Smith, SPT; Jonathan Koo, SPT; East Carolina University, Greenville, NC
       The use of antiseptic preparations in open wounds has been an area of contention among wound management practitioners for years. However, novel antiseptic preparations have been developed that appear to exhibit minimal to no detrimental effects on wound healing. The purpose of this study was to perform an in vitro comparison of the effectiveness of new antiseptic dressings on gram + and - micro-organisms resistant to mainstream antibiotics. MRSA (ATCC # 33591) and Pseudomonas aeruginosa (PA, ATCC # 27853) were plated separately on Sheep Blood Agar (SBA) at 106 and allowed to air dry. Sterile, 22 mm x 22 mm squares of test dressings were placed on the cultures and then cultures were incubated at 30 degrees for 24 hours. Zones of inhibition were measured for each test dressing and numbers of organisms present under each dressing were counted. Effects of plain gauze dressing were compared to silver and cadexomer iodine-based (CIB) dressings. Only the CIB-treated cultures demonstrated complete inhibition of growth for MRSA and PA. The CIB dressing demonstrated a 97.5% and 76.4% greater zone of inhibition for MRSA and PA, respectively compared to the next most effective dressing. In vitro, the CIB dressing appeared to have the greatest antimicrobial effect.

Quality of life changes during treatment for chronic leg ulceration
Peter J. Franks, PhD; Debra C. Doherty RN; Christine J. Moffatt, RN PhD; Centre for Research & Implementation of Clinical Practice, Thames Valley University, London, UK.
       Studies that have examined patients’ health-related quality of life (HRQoL) have generally demonstrated improvements following intensive and effective treatments. However, little is known of the long-term effects of treatment on patients. As part of a study in South West London (UK), all patients suffering from a current leg ulcer were examined, interviewed with the Nottingham Health Profile and followed up at 6 months and 1 year.
       The patients had a mean (SD) age of 76 (13) years with 72 (64%) being women. Prior to the study, the ulcer had been present for a median of 8 months (range 0.8 to 144), and 29100 (29%) patients had an area of ulceration larger than 10 cm2 (range 0.5 to 171.5 cm2). After 6 months, there was a significant improvement in pain (mean difference [d]=9.6, P = 0.002), which was true for both the 41 patients with ulcers (d=10.0, P = 0.01) and the 43 patients whose ulcers had closed (d=9.1, P = 0.047). However, after 1 year these improvements had been sustained by the patients with ulcer closure (d=8.6, P = 0.078), but not by the patients whose ulcers remained open (d=2.1, P = 0.69). Energy, which had improved after 6 months in the patients whose ulcers had closed, deteriorated in all patient groups after 1 year.
       The positive effects of treatment on HRQoL may not be sustained over time. This may be a consequence of the general deterioration in health status of these elderly patients as they age.