Cath Lab Digest

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  The concept of wound bed preparation is now accepted in clinical practice as a framework for the management of chronic wounds.¹ It is recognized that chronic wounds have become “stuck” in the inflammatory and proliferative stages of healing² and require an approach to healing that differs from what is used in acute wound management.

  The aim of wound bed preparation is to create an optimal wound healing environment by restoring the bacterial balance and by managing slough, necrosis, and exudate. Wound bed preparation also involves correcting cellular dysfunction and restoring the biochemical balance within the wound.^3,4 Clinicians who deal with chronic wounds on a daily basis aim to manage these factors by judiciously observing patients and their wounds and responding with the appropriate use of supportive techniques and/or technologies to prevent complications and promote wound progression.

  In practice, wound bed preparation may be a challenge, not only because of the complexity of the patient and his associated comorbidities, but also because appropriate techniques to prevent complications are not always available. One example is the removal of devitalized tissue from the wound bed; if left in place, this tissue delays healing, is a focus for infection, and increases the risk of chronic inflammation.⁵ Access to quick and effective tissue removal techniques such as sharp surgical, larval, or hydrosurgical debridement may not be readily available to practitioners working outside specialty or hospital environments.

  Assessing the bacterial load in a wound is also difficult. The clinician must rely on identifying the signs and symptoms that indicate developing infection — ie, delayed healing, increasing exudate, bright red discoloration of granulation tissue, purulent discharge, edema, increased heat, malodor, undermining of the wound edges, and possible wound breakdown.⁶ Preventing wound infection is a major challenge in chronic wounds; clinicians now rely on the use of antimicrobial dressings as one technique to restore the bacterial balance once it is found to be a problem.

  Managing wound exudate and associated periwound complications often is accomplished using absorptive dressings, removing the harmful fluid while maintaining a moist healing environment.

  To determine whether a dressing could be used within the wound bed preparation framework and was suitable for use with standard care, a new hydroconductive dressing with Levafiber technology (Drawtex, SteadMed Medical LLC, Ft. Worth, TX) was evaluated on 10 patients with nonhealing chronic wounds. No protocol other than the manufacturer’s recommendations was utilized, and patients were not randomized to treatment. The only information recorded was collected during routine assessment. Organizational consent was obtained from the hospital, along with that of the patient’s medical practitioner. The patients also gave written consent to participate, including the use of photography for educational and publication purposes.

  All patients were male, average age 60 years (range 46 years to 78 years). The patients were managed on a day-to-day basis by the Home Nursing Service and were seen by the wound care nurses at the hospital center for specialist advice. This approach facilitated thorough assessment of the dressing in use and its risk/benefit effects to the patients and the organization within day-to-day clinical practice. As such, ethical approval was not required within the UK.

  This cohort of patients had presented with nonhealing wounds that included seven complex surgical wounds, one traumatic wound, and two leg ulcers being treated with compression therapy.