Volume 54 - Issue 9 - September, 2008
The Standing Heel-Rise Test: Relation to Chronic Venous Disorders and Balance, Gait, and Walk Time in Injection Drug Users
- 0 Comments
- 9874 reads
Index: Ostomy Wound Manage. 2008;54(9):18-32.
Mobility impairment is an unintentional and largely unrecognized consequence of injection drug use (IDU). This impaired mobility in combination with other potential pathologic changes to the veins, muscles, and joints of the lower legs from IDU may lead to the development of chronic venous disorders (CVD). Chronic venous disorders of the lower extremities may cause swelling, varicose veins, skin damage, refractory ulcers, and pain1 — progressive and debilitating sequelae. Injection drug users with CVD often complain of mobility problems such as difficulty with walking, stair climbing, and working.2,3 Previous research4 found evidence of CVD in 87% of persons in a methadone maintenance treatment program; by contrast, additional research found CVD affects 7% to 9% of the general population and occurs late in life.3,4
The calf muscle pump is a critical component of the conceptual model describing the relationship between CVD and mobility impairments. In addition to its role in a functional venous system, the calf muscle pump is dependent on ankle joint flexion for the compression motion that leads to venous emptying by forcing venous return to the central circulation.5 Changes to the musculoskeletal system of the lower leg can adversely affect the dynamics of the calf muscle pump.
The Nutritional Status of Older Adults with and without Venous Ulcers: A Comparative, Descriptive Study
- 0 Comments
- 7786 reads
Index: Ostomy Wound Manage. 2008;54(9):34-42.
The nutritional requirements of healthy people differ from those who have chronic wounds and while it is generally suggested that the nutritional status of persons with chronic wounds must be addressed, actual data about the nutritional status of older adults with venous ulcers is limited. The nutritional status of hospitalized older adults (n = 40, average age 77 ± 7.4) with vascular disease was compared to randomly selected outpatients with venous insufficiency ulcers (n = 37, average age 70.4 ± 8.13) using the Mini Nutritional Assessment instrument. Among all patients assessed, 37 (48%) were at risk for malnutrition or were malnourished. No differences between nutritional status and age or gender were found. The proportion of patients at risk for malnutrition or currently malnourished was significantly higher in the venous ulcer (24 out of 37) than in the control group (13 of 40, chi2 = 15.51, P < 0.05). Statistically significant differences were found between the control and venous ulcer group for all anthropometrical assessment variables (BMI, arm circumference, calf circumference, and weight loss in past 3 months), use of more than three prescription drugs, dietary history/assessment (appetite, fluid consumption, independent feeding), and patient self-rated health. The results of this study confirm that a complete patient assessment must include evaluating patient nutritional status and that nutritional disorders are a serious problem among the elderly, especially those with venous ulcers. Additional studies to help optimize the nutritional assessment and management of older adults with venous ulcers are needed.
KEYWORDS: nutritional assessment, malnutrition, venous ulcer, elderly, comparative study
- 1 Comments
- 19009 reads
Index: Ostomy Wound Manage. 2008;54(9):44-48.
Abdominal wound dehiscence is a major postoperative complication with a high mortality rate. Although the mainstay of management is immediate operative reclosure, critically ill patients are better served by conservative temporary measures and delayed operative closure. The evidence in the literature regarding the use of biosynthetic implants in abdominal wound dehiscence is limited. To expand knowledge of management options, a case of abdominal wound dehiscence post hysterectomy in a critically ill 69-year-old woman managed with placement of a porcine dermal collagen implant is described. The porcine dermal collagen implant was placed in an infected field for the repair of the fascial defect under local anesthesia. No additional surgery was required and, 9 months post surgery, the patient remained healthy without evidence of residual hernia. Biosynthetic implants may be an effective alternative for the acute management of fascial dehiscence in critically ill patients.
KEYWORDS: wound dehiscence, surgery, complications, infection, biosynthetic implant.
- 0 Comments
- 2572 reads
In August 2007, the Center for Medicare and Medicaid Services (CMS) endorsed a policy of nonpayment for Stage III and Stage IV hospital-acquired pressure ulcers effective October 2008.1 Policy has an interesting way of shaping both science and practice. Undoubtedly, this new CMS ruling will be a stimulus for intensifying prevention practice and developing new approaches for systematically monitoring the effectiveness of prevention efforts. However, we hope it will have the added effect of advancing the science of pressure ulcer prevention.
The science of pressure ulcer prevention, like medicine and nursing, is a practical one. The focus of practical sciences is to develop and structure knowledge about things that are doable2,3 — eg, curing a disease, promoting patient self-care, preventing pressure ulcers. Thus, the aim of practical sciences might be understood as one of developing responsible descriptions and explanations (conceptual models or theories) about things that are doable. When it comes to the science of pressure ulcer prevention, the focus seems to be on describing and explaining three doable things: 1) identifying who is at risk for getting pressure ulcers, 2) designing appropriate prevention plans, and 3) effectively implementing prevention interventions. However, what unifying conceptual model or theory drives our investigation of these prevention activities?
- 0 Comments
- 3222 reads
A clean, beefy-red wound bed often represents a good sign of wound healing. However, many interventions may be necessary before a wound reaches this point. As a general surgeon, I am often asked to consult on wounds that clearly require debridement. Although many necrotic wounds can benefit from surgical debridement, some patients are not candidates for this procedure because of their overall condition, the care setting lacks access to a surgeon or other appropriate licensed provider, or the overall wound treatment objective is not compatible.
Meeting the Challenges of Wound-associated Pain: Anticipatory Pain, Anxiety, Stress, and Wound Healing
- 0 Comments
- 6781 reads
Pain is an unpleasant physical and emotional experience that plays a key role in the lives of people with chronic wounds.1-3 It is well documented that the majority of patients with chronic wounds suffer from moderate to severe pain for a protracted period of time with frequent exacerbations.4-8 Although pain often is associated with conditions intrinsic to underlying etiologies (eg, acute lipodermatosclerosis in venous leg ulcers, Charcot changes with diabetic foot ulcers), trauma (pressure, shear, and friction), chemical irritation, infection, or inflammation, spontaneous pain may occur due to sensitization of nerve fibers.9 In studies conducted during dressing changes, patients describe the most excruciating pain at dressing removal as aggressive adhesives are peeled away from fragile and damaged periwound skin.10-13 Increasing evidence also validates pain with wound cleansing, especially when abrasive materials or forceps are used to remove debris from the wound bed.3,14,15
- 0 Comments
- 3657 reads
Ostomy Wound Management congratulates the the 2008 World Union of Wound Healing Societies (WUWHS) Congress Lifetime Achievement honorees. Their contributions to the advancement of wound management underscore their passion for their scope of practice.
Barbara J. Braden, PhD, FAAN. Dean of University College at Creighton University, Omaha, Neb, Dr. Braden is best known for her work in the development of the Braden Scale for Predicting Pressure Sore Risk, now available in 20 languages.
Negative Pressure Wound Therapy Combined with Acoustic Pressure Wound Therapy for Infected Post Surgery Wounds: A Case Series
- 0 Comments
- 6024 reads
Acute infection of surgical incision sites often requires specialized wound care in preparation for surgical closure. Optimal therapy for preparing such wounds for a secondary closure procedure remains uncertain. The authors report wound outcomes after administering acoustic pressure wound therapy in conjunction with negative pressure wound therapy with reticulated open-cell foam dressing changes to assist with bacteria removal from open, infected surgical-incision sites in preparation for secondary surgical closure in three patients. Before incorporating acoustic pressure wound therapy at the authors’ facility, the average negative pressure wound therapy with reticulated open-cell foam dressing course prior to secondary surgical closure was 30 days; with its addition, two of three patients underwent successful surgical closure with no postoperative complications after 21 and 14 days, respectively; one patient succumbed to nonwound-related complications before wound closure. Larger, prospective studies are needed to evaluate combining negative pressure wound therapy with reticulated open-cell foam dressing and acoustic pressure wound therapy for infected, acute post surgery wounds.
KEYWORDS: acoustic pressure wound therapy, wound care, infection, surgery, negative pressure wound therapy
- 0 Comments
- 3856 reads
Nonwoven silver antimicrobial dressing is absorbent, minimizes pain
Mölnlycke Health Care (Norcross, Ga) introduces Melgisorb® Ag — a new antimicrobial ionic silver dressing. The dressing is a nonwoven pad composed of alginate, CMC fibers, and ionic silver. The ionic silver provides sustained silver release and antibacterial effect up to 4 days. The alginate and CMC fibers limit maceration to the wound because of low lateral wicking. The dressing creates a hydrophilic gel in contact with wound exudate for a moist environment that facilitates wound healing. Damage of newly formed tissue is reduced and pain is minimized at dressing changes because the gel does not adhere to the wound.
The dressing can be used for patients with postoperative surgical wounds, leg ulcers, pressure ulcers, diabetic ulcers, graft and donor sites, and trauma wounds. Laboratory tests show it absorbs up to 45% more than the market leading silver hydrofiber dressing. The dressing is designed specifically for deep wounds and has a wet strength that allows for removal in one piece.