An abundance of research supports nutrition guidelines for treating pressure ulcers, but published guidelines on medical nutrition therapy for postsurgical wounds do not exist. Surgical wounds are distinctly different from chronic types of wounds; key factors in nonhealing surgical wounds are ischemia and bacterial colonization, which stall healing in the inflammatory stage.¹ Primary wound healing typically begins within hours of closing a surgical incision.² Nevertheless, the principle goals of wound healing are to eliminate factors that may complicate or delay wound healing, and then optimize the wound healing environment^3,4 (see Table 1). Some factors that may complicate or delay wound healing can be addressed (at least partially) through nutrition.

  Obstructive defecation syndrome (ODS) is a complicated-sounding term for chronic constipation. It involves difficulty in passing stool, hard stool, straining for more than 15 minutes, or incomplete evacuation occurring at least weekly and continually for 6 months or more. An interdisciplinary team at the University of California San Francisco (UCSF) analyzed data from the Reproductive Risks for Incontinence Study at Kaiser (a population-based cohort of racially diverse women, 40 to 69 years old) and determined a 12.3% ODS prevalence in women — ie, ODS is a common occurrence in middle-aged women. Women in the database who had undergone laparoscopic/vaginal hysterectomies or surgery for pelvic organ prolapse or urinary incontinence had nearly twice the risk of weekly obstructive defecation, signaling a direct connection between ODS and underlying pelvic floor disorders.¹

Index: Ostomy Wound Manage. 2012;58(2):24–32.

Abstract

  Pressure ulcer (PU) development remains a significant complication among at-risk patients. Optimal prevention strategies start with knowledge about current evidence-based prevention interventions. A pilot study was conducted to describe nurses’ level of knowledge of PU preventive interventions and to test the reliability of the Pressure Ulcer Knowledge Test (PUKT) among Nigerian nurses. One hundred, eleven (111) nurses were purposively selected from specific wards of a state teaching hospital in South West Nigeria. While 106 nurses (95.5%) correctly identified patients at risk for PU development, 78 participants (70.3%) had low (<59% correct) prevention intervention knowledge scores. No significant differences in PU prevention intervention knowledge scores were observed between nurses with different educational backgrounds (P = 0.317) or years of working experience (P >0.005). The Cronbach’s alpha coefficient for reliability was 0.861. The results of this study confirm that many PU prevention interventions in Nigeria are based on tradition and that a structured educational approach is needed to enable Nigerian nurses to provide evidence-based PU prevention interventions.

Index: Ostomy Wound Manage. 2012;58(2):41–46.

Abstract

  The cost of pressure ulcers, especially Stage III and Stage IV ulcers, is substantial. A 27-year-old man with a 6-year history of quadriplegia developed an ischial pressure ulcer. Twelve months of treatment with wet-to-dry dressings were followed by admission to several facilities and 15 months of care with biological dressings and negative pressure wound therapy (NPWT). When admitted to the authors’ wound care center, the wound measured 4.5 cm x 3.2 cm with exposed bone. A review of his insurance records showed that paid claims totaled $242,350, including $52,992 for NPWT rental costs. The patient was considered a good candidate for minimally invasive surgical intervention with external tissue expanders. Following a 14-day course of antibiotics to treat his infection, the wound was debrided and the tissue expanders applied. After 16 days, the wound was closed. The patient returned to work 6 weeks after the procedure. At the 23-month follow-up, the wound remained closed. Insurance payments for the care that resulted in wound closure totaled $43,814. This case study illustrates the potential of the external tissue expansion technique to close deep pressure ulcers within a relatively short amount of time at comparatively lower cost. Studies including control treatments are needed to confirm these conclusions.