Pearls for Practice

Pearls for Practice: Closing Wounds Resulting From Cancer Removal Under Local Anesthesia Using Micro-autografts in the Wound Clinic

  Many skin cancers, including basal cell carcinomas, squamous cell carcinomas, and superficial malignant melanomas, are removed using Mohs’ micrographic surgery techniques.1,2...

Pearls for Practice: Significant Cost Savings Realized by Changing Debridement Protocol

Recently, hypochlorous acid (Vashe Wound Solution, SteadMed Medical, LLC, Fort Worth, TX) has been reported to be effective at soft debridement when used as a wound soak followed by wiping of the wound.2...

Pearls for Practice: Wound Closure With Autologous Epidermis and Dermis in the Outpatient Wound Clinic Setting

Wound bed preparation is the management of a wound in order to accelerate endogenous healing or to facilitate the effectiveness of other therapeutic measures.1 The goal of wound treatment is to optimize wound bed preparation to allow the wound to proceed to endogenous healing or to set the stage for successful wound closure with autologous tissue....

Pearls for Practice: Hypochlorous Acid and Hydroconductive Dressing Used in Conjunction for Management of Complex Wounds

  Hypochlorous acid (HOCl) is a substance in the body that kills invading pathogens by the oxidative burst in neutrophils. It has been demonstrated to decrease bacteria both in vitro and in vivo and to be noncytotoxic.1 Other antiseptics, such as sodium hypochlorite or hydrogen peroxide, are cytotoxic to fibroblasts. The HOCl used in this series, Vashe Wound Therapy (SteadMed Medical LLC, Fort Worth, TX), has a pH similar to skin and has been demonstrated to be useful in a variety of wounds.2 ...

Pearls for Practice: Treating Enterocutaneous Fistulas With a Hydroconductive Dressing

  An enterocutaneous fistula (ECF) is an abnormal communication between the small or large bowel and the skin. ECFs most frequently occur postoperatively; the ileum is the most common source of origin.1 ECFs have posed vexing problems for clinicians since first described by Celsus in 53 BC.2 They are classified based on the amount of output of enteric contents as low output (<200 cc/day), moderate output (200–500 cc/day), and high output (>500 cc/day).3

  The standard treatment for an ECF is conservative because most fistulas will close spontaneously and operative attempts at fistula closure are fraught with complications.2 The patient needs to receive supportive care because electrolyte imbalance is common, depending on the amount of the loss of enteric contents containing fluid and electrolytes. ...

Pearls for Practice: Hydroconductive Dressings Used To Heal Dehisced Surgical Wounds: A Case Series

  In 2011, a novel class of dressings, hydroconductive dressings (HCD), was introduced at the Symposium on Advanced Wound Care.1 The unique action of this dressing (Drawtex Hydroconductive Wound Dressing, SteadMed Medical, LLC, Fort Worth, TX) draws wound exudate both horizontally and vertically into the dressing,2,3 draws debris and slough from the wound, and draws bacteria and deleterious cytokines from the wounds.4-6 Although this topical therapy is most commonly associated with highly exudative wounds such as venous leg ulcers, we also have been utilizing it with great success in the treatment of acutely dehisced surgical wounds. We present our experiences with four dehisced surgical wounds that were treated with the HCD. In each case, the patient’s wound had been treated for at least 2 weeks with an alternative product and did not progress within expected norms of wound healing. ...

Pearls for Practice: Hypochlorous Acid: Its Multiple Uses for Wound Care

  In today’s medical environment, it is necessary to get the most out of the products we have at hand. When we can find a tool that can be utilized in many ways and still be cost effective, we need to take advantage of it. One such product is hypochlorous acid (HOCl). Although basically a wound cleanser, we have utilized it in our practice for much broader indications....

Pearls for Practice: Using Hydroconductive Dressings on Wounds Where Healing is Delayed due to Steroid or Immunosuppression Therapy

  Wound bed preparation is the management of a wound in order to accelerate endogenous healing or to facilitate the effectiveness of other therapeutic measures.1 The concept wound bed preparation has evolved to provide a systematic approach to removing the barriers to natural wound healing and enhancing the effects of wound therapies.2 To be effective in wound bed preparation, a product has to facilitate debridement of necrotic tissue and debris, decrease excessive wound exudate, decrease the tissue bacterial level, remove deleterious chemical mediators, and set the stage for acceleration of endogenous healing.3 ...

Pearls for Practice: Objective Quantitative Analysis of Wound Bed Preparation for Pressure Ulcers and Venous Leg Ulcers Utilizing a Hydroconductive Wound Dressing

  The concept of wound bed preparation provides a systematic approach to removing the barriers to wound healing and enhancing the effects of wound therapies.1 An effective product for wound bed preparation needs to facilitate removal of nonviable tissue and debris, decrease excessive exudate, decrease the tissue bacterial level, remove deleterious chemicals, and set the stage for healing.2 Spruce3 suggested in a series of cases that the hydroconductive dressing, Drawtex (SteadMed Medical LLC, Ft. Worth, TX), was such a product and could be used effectively within the wound bed preparation framework. ...

Pearls for Practice: A Novel Tracheostomy Dressing: Extension of a Hydroconductive Wound Dressing

  Tracheostomies, which may be acute or chronic, are indicated for different conditions such as chronic obstructive pulmonary disease (COPD); bacterial, viral, or fungal pneumonia; smoke inhalation; and head injury,1 to name a few. The secretions exiting or being suctioned from the tracheostomy site associated with each of these conditions have unique characteristics2; the exudate can be copious, watery bronchorrhea; bloody; viscous; and/or contain varying amounts of exudate, debris, bacteria, and chemicals depending on the etiology of the tracheostomy. A tracheostomy to relieve thick secretions in a case of severe bacterial pneumonia will have exudate heavily laden with bacteria.3 A tracheostomy performed for COPD may have injurious cytokines and proteases in the exudate removed from it.4 A tracheostomy performed to aid in the treatment of smoke inhalation will yield debris such as carbon particles and inflammatory cytokines.5...