Editorial Staff

Editor Barbara Zeiger

Assistant Editor Lauren Mateja

Web Content Coordinator Katherine Blessing

Editorial Correspondence

Barbara Zeiger, Editor, OWM

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January 2014 ISSN 1943-2720 | Volume 60 - Issue 1

Providing Quality Skin and Wound Care for the Bariatric Patient: An Overview of Clinical Challenges


  Obesity, (defined as body mass index [BMI] ≥30), and especially morbid obesity (defined as BMI ≥40), has a profound impact on the health and integrity of the patient’s integumentary system and on the caregivers who strive to provide care for larger, heavy patients. The purpose of this overview is to address some common skin and wound care issues faced by bariatric patients in order to inform clinicians, patients, and caregivers and enable them to optimize care. For bariatric patients, extra attention must be paid to skin care, cleanliness, skin fold management, perigenital care, odor management, and effective pressure redistribution. Despite these interventions, the multifactorial challenges presented by morbid obesity increase patient risk for serious skin diseases and wound conditions. Implications for practice include how best to educate patients and caregivers for optimal problem prevention. Future research should target improving bariatric care equipment and decreasing risk indices.

 Potential Conflicts of Interest: none disclosed ...

The Role of Obesity in the Patient Undergoing Colorectal Surgery and Fecal Diversion: A Review of the Literature


  The obese colorectal surgery patient may face several challenges, including a high risk for the development of colorectal cancer, an increased risk for complications with diverticular disease, and surgical risk factors including anastomotic leaks, inability to perform a low anastomosis, and septic complications. The purpose of this literature review was to examine available data on the implications of obesity on colorectal disease and colorectal surgery, particularly stoma surgery. Obesity has been documented as a risk factor for colorectal disease, but results of studies examining surgery-related problems secondary to obesity are inconsistent. However, clinicians generally believe obese patients undergoing colorectal surgery may be at higher risk of complications than their non-obese counterparts. The obese patient requiring the creation of a fecal diversion may encounter stoma-related issues such as stenosis, retraction, and inability to maintain a consistent pouching system seal. Stoma site marking can be challenging because of the large shifts in subcutaneous tissue and the inability for a person with a large abdomen to be able to visualize the stoma if the stoma is placed too low on the abdomen. Additional research to elucidate complication rates and risk factors is needed to help clinicians develop optimal plans of care.

Potential Conflicts of Interest: none disclosed ...

Massive Localized Lymphedema, a Disease Unique to the Morbidly Obese: A Case Study


  Massive localized lymphedema (MLL) is a unique presentation of lymphedema resulting in a large, benign, painless mass that develops in morbidly obese patients, most commonly on the medial thigh. Because nearly 6% of the United States adult population is morbidly obese, MLL is believed to be under-diagnosed. To better guide the clinician in identifying and treating MLL, a case study of a 44-year-old Caucasian woman with type I diabetes who presented to the study wound care clinic with MLL is reported, along with the experience of managing more than 70 patients with MLL. A diagnosis of MLL is usually made based on clinical history and presentation. Routine tissue biopsy is not advisable, and diagnostic tests such as magnetic resonance imaging (MRI) may be impossible due to the morbid obesity of most patients. Complete decongestive physiotherapy (CDP) is recommended. Although surgical removal of the MLL collection may be possible, it is technically difficult and not always advisable due to the risk of perioperative complications, including wound dehiscence. Furthermore, in the author’s experience, recurrence is possible even after surgical removal, particularly if conscientious adherence to compression and weight management do not continue. The advent of advanced pneumatic compression devices designed for the morbidly obese and the possibility of using near-infrared fluorescence imaging to guide treatment may transform the MLL management process. Considering the increasing number of MLL cases, the comorbidities and complexities of treating morbidly obese patients, and associated complications, clinicians caring for the morbidly obese need a heightened awareness of this condition.

 Potential Conflicts of Interest: Dr. Fife is Chief Medical Officer, Intellicure, Inc, The Woodlands, TX. ...

A Pictorial Overview of Technology-assisted Care Options for Bariatric Patients: One Hospital’s Experience


  Best practice guidelines to avoid pressure ulcers and skin breakdown among obese patients include early and progressive mobility, rigorous turning schedules, and proper skin care. However, implementation of some these guidelines may increase the risk of patient and caregiver injury. An acute care hospital implemented safe patient handling protocols that involved equipment purchase and extensive training for all care staff. The new equipment facilitated repositioning, including boosting and turning, lateral transfers, vertical transfers and ambulation, and bathing and toileting. All healthcare facilities are expected to see an increase in the number of bariatric patients and need for safe patient handling protocols and procedures. At the same time, research is needed to evaluate the safety, effectiveness, and cost-effectiveness of currently available devices designed to improve patient safety and reduce caregiver injury.

 Potential Conflicts of Interest: Ms. Arnold provides consulting services for several safe patient handling and mobility companies. ...

Guest Editorial: The Intersection of Ostomy and Wound Management, Obesity, and Associated Science

  In 1997, Ostomy Wound Management published one of the first articles addressing the common, predictable, and preventable skin and wound challenges associated with obesity.1 Since then, a number of important articles have emerged from the journal. As the science of ostomy and wound management intersects with other disciplines, opportunities to improve patient care, many detailed in this special issue of OWM, are rapidly forthcoming....

My Scope of Practice: Utilizing Technological and Human Resources

 As someone dedicated to providing the best possible care for patients with ostomies, wounds, and continence issues, Mary Mahoney, MSN, RN, CWON knows that extraordinary times call for extraordinary changes in the way patients are managed.

  Mary’s journey as a nurse began upon completion of her Associate Degree in Nursing at Des Moines Area Community College in 1984; she subsequently earned a Bachelor of Science in Nursing in 1991 and Masters degree in May 2013 from Drake University (Des Moines, IA). ...

AAWC Update

The new year brings a wealth of exciting changes to the Association for the Advancement of Wound Care (AAWC).

New Mission Statement:

To advance the care of people with and at risk for wounds.

  Although the previous mission statement — to be the leader in interprofessional wound healing and tissue preservation — certainly typifies the capacity of members within our organization, the AAWC Board of Directors decided at our recent 5-year strategic planning session to clarify our message. This change to our mission statement concisely describes why clinicians, patients, and their lay-caregivers joined together to create the leading collaborative, interprofessional healthcare organization in the United States. ...

New Products and Industry News

Prescription wound care products introduced

  Oculus Innovative Sciences, Inc (Petaluma, CA) introduced two new products to its United States family of Microcyn-based advanced wound care products. Microcyn Wound & Skin Spray HydroGel now comes in a sprayable formulation, allowing it to be easily and conveniently sprayed directly onto the wound site. Available in a 3-oz spray bottle, this newest advance in hydrogel technology is reimbursable via HCPCS A6248. Microcyn Wound & Skin Care with preservatives is available for the first time in a multi-use 2-oz spray bottle. Used to cleanse, irrigate, and aid in the debridement of a vast array of chronic and acute wounds, this product can be used before application of a variety of wound healing products and methods, including products with silver, enzymatic debriders, growth factors, tissue-engineered products, and dermal substitutes. The reduced bottle size allows use in the clinic, as well as economically dispensed or prescribed for patients’ in-home use.

  For more information, visit www.oculusis.com. ...