BACKGROUND:Venous leg ulcers (VLUs) are associated with various physical and social adverse effects for patients but also contribute to a significant socioeconomic burden. PURPOSE:To examine the clinical performance and safety of a collagen-alginate dressing in combination with standard wound care in non-healing VLUs. METHODS:In an observational, explorative, single-center study, VLUs of 60 patients were covered with a collagen-alginate dressing. Wounds were assessed during 5 visits over a 4-week period. At the final visit, health care professionals gave an overall assessment of the dressing. Outcome parameters were wound area reduction, wound pain, wound-related quality of life (QoL), and incidence of adverse events. RESULTS:The mean wound area decreased (17.8 ± 11.2 cm² versus 11.4 ± 9.0 cm²; P < .0001), and 4 patients achieved complete closure. Wound pain decreased after 2 weeks, and intake of analgesics reduced. Patients' wound-related QoL improved and a correlation between the well-being sub-score and wound area reduction was found. All health care professionals rated the collagen-alginate dressing as 'very good' or 'good.' CONCLUSION:The collagen-alginate dressing is safe and effective in promoting healing and addressing the pain of VLUs. It also improves patients' QoL, possibly by reducing wound area, pain, and exudate.
BACKGROUND:Traumatic injuries have increased risks for infection and progression to difficult-to-heal wounds. Often, they are inadequately treated with single-purpose dressings. Involving wound care specialists allows for integrating various advanced wound treatments. The objective of this report was to assess if healing rates correlated with using unique combination therapies. METHODS:An observational, prospective analysis was performed, reviewing patients with acute wounds from admission until healed. Systematic assessments were standardized, employing T.I.M.E. (tissue, infection /inflammation, moisture balance, edge/periwound). Key outcomes included wound progression, dimensions, treatments, healing time, and health care utilization metrics. RESULTS:A total of 124 patients with acute wounds up to 1120 cm3 healed using multimodal therapy. Median time to wound specialist consultation was 2 days. It was determined that all patients were treated with a pure hypochlorous acid-based wound cleanser combined with negative pressure wound therapy, collagen, silver, manuka honey, and/or foam dressings. Median healing time was 19 days. Delays were associated with smoking, immunocompromise, and inability to obtain wound care supplies. CONCLUSIONS:Optimizing advanced therapeutic combinations with innovative dressings, including pHA and other beneficial components, has shown reduced health care utilization of acute wound patients by shortening healing time. The resulting decrease in dressing changes, follow-up appointments, and home care could increase patient satisfaction and improve outcomes.
Background: A wound must progress through serial steps of healing to achieve structural and functional stability. This process is hampered in chronic wounds and wounds with delayed healing. Wound cover through skin grafting or a flap, or spontaneous healing through epithelization, requires healthy granulation tissue. Wound infection inhibits the formation of such tissue. Material and Methods: This study included 24 cases of chronic wounds with large raw areas that did not respond to conventional therapy for more than 3 weeks. Wounds were treated with 2% citric acid ointment with the aim of promoting healthy granulation and appropriate wound bed preparation. Infective agents, their sensitivity, and response to citric acid were studied. Results: Thirty-two bacterial strains were isolated. The most common was Staphylococcus aureus (12, 37.5%), followed by Pseudomonas aeruginosa (8, 25.0%). The majority of isolates were resistant to multiple antibiotics. The study’s endpoint was the appearance of healthy granulation tissue suitable for split-thickness skin grafting or healing by secondary intention. Application of 2% citric acid ointment resulted in the formation of healthy granulation tissue in all cases after 3 to 20 applications. Conclusion: Citric acid ointment (2%) is highly effective in controlling infections and promoting formation of healthy granulation tissue.
BACKGROUND:Cancerous wounds are a significant challenge in cancer care, reducing the quality of life and affecting psychological well-being. PURPOSE:This case report describes a 59-year-old female who developed a severe cancerous wound. The report presents comprehensive nursing measures for patients with cancerous wounds and discusses key nursing factors that promote wound healing. CASE STUDY:The patient, diagnosed with stage Ⅲ B ALK-negative anaplastic large cell lymphoma, developed a severe cancerous wound. Specialist nurses developed a detailed wound care plan during 2 inpatient chemotherapy sessions, including wound care, pain management, nutrition support, psychosocial support, and continued transitional care after discharge. Her wound decreased in size and eventually healed. CONCLUSION:Implementing nursing measures for patients with cancerous wounds-including assessment of systemic and local wounds, wound care, pain management, nutrition support, psychosocial support, health education, and transitional care-can help manage wounds and lead to complete healing. Specialized nurses play a key role in treating severe wounds. This case highlights the need for comprehensive and scientific nursing practices for patients with cancerous wounds. It conveys a positive attitude towards treatment and a sense of responsibility among nurses.
BACKGROUND:Early esophageal fistula formation following anterior cervical spine surgery presents a formidable clinical challenge, necessitating astute rehabilitative nursing management. Such fistulas, if not promptly and effectively managed, can precipitate grave complications including mediastinitis, sepsis, respiratory failure, and, in severe instances, mortality. This underscores the critical need for immediate, comprehensive nursing interventions designed to mitigate these risks and enhance patient outcomes. Esophageal fistula is a rare but consequential complication after anterior cervical discectomy and fusion (ACDF), with numerous pathogenetic factors. Proactive preventive and interventional treatments are the key to rapid recovery. CASE REPORT:In this case report, a 64-year-old female was discharged from the hospital 82 days after surgery with full recovery after a personalized rehabilitation care program based on the enhanced recovery after surgery (ERAS) concept. CONCLUSION:It is important to consider follow-up in patients with spontaneously healed esophageal perforations. Aggressive prevention, early identification, and interventional treatment are key to reducing postoperative pain and facilitating recovery.
BACKGROUND:The presence of heavy microbial colony formation, polymicrobial infection, and local altered pH contribute to the high rate of postoperative complications following surgical reconstruction of stage IV pressure injuries (PIs). PURPOSE:The objective of this study was to determine the rate of bacteria-related postoperative complications following surgical reconstruction of stage IV PIs in which a pure hypochlorous acid (pHA) antimicrobially preserved wound cleaning solution was used. METHODS:This 1-year retrospective review evaluated the outcomes of patients who underwent surgical reconstructive treatment of chronic stage IV PI. Surgical management consisted of wide debridement, intraoperative cultures, and irrigation with 8 to 10 minutes indwelling of a pHA antimicrobially preserved wound cleaning solution prior to closure and application of incisional negative pressure wound therapy (iNPWT). RESULTS:Thirteen patients (18 chronic, stage IV PIs) were included in the study. Intraoperative cultures were positive for 10/18 wounds (55.6%). A bacteria-related postoperative complication occurred in 1 patient (1/13, 7.7%; postoperative dehiscence requiring reoperation). CONCLUSIONS:Adjunctive irrigation and indwelling of a pHA antimicrobially preserved wound cleansing solution in the surgical management of chronic, stage IV PIs in this 1-year retrospective review resulted in a 7.7% bacteria-related postoperative complication rate.
BACKGROUND: Persons with diabetes often face significant foot problems due to inadequate foot care, and foot care training programs could be beneficial for these patients. PURPOSE: To examine the effects of diabetic foot care training on self -efficacy and adaptation based on Social Cognitive Theory and the Roy Adaptation Model. METHODS: In this randomized controlled study, 80 patients treated in the endocrine polyclinic of an education and research hospital in & Idot;zmir, Turkey, were randomized to intervention (n = 40) or control (n = 40). The intervention group received diabetic foot care training at 1 month, 3 months, and 6 months. Using a diabetic foot model, foot care training was given on diabetic foot care practices; in addition, a foot care training booklet prepared by the researchers was provided. Foot care behaviors, self -efficacy, and adaptation were reevaluated after the training and education. Data were collected at baseline, 1 month, 3 months, and 6 months in both groups. RESULTS: Diabetic foot care training and telephone follow-up were effective in improving foot care behaviors and facilitating the coping and adaptation process of individuals with diabetes, as well as in increasing their self -efficacy regarding foot care. CONCLUSIONS: When providing theory -based diabetic foot education, the use of visual materials along with verbal instruction as well as telephone follow-ups to evaluate training effectiveness increases patients' self -efficacy and adaptation.
Background: Hospital-acquired occipital pressure injuries are a preventable cause of morbidity and mortality in the perioperative setting. Purpose: To find the occipital cushion/pillow with the lowest measured peak pressures and the highest measured surface area using pressure mapping technology. Materials and Methods: A quality improvement project involving 3 operating room staff volunteers was conducted using pressure mapping. Five different pillows were tested based on what the study location commonly used and had available. The pillows included: standard pillow with pillowcase, non-powered fluidized positioner, medium-sized (17 × 17 × 1.5 inches) static seat cushion placed under the shoulders and head, pediatric-sized (13 × 13 × 2 inches) static air cushion placed under the head, and foam donut. Results: The non-powered fluidized positioner had the highest average pressure and peak pressure for all 3 volunteers. The medium static air seat cushion had the lowest average and peak pressures for 2 out of 3 volunteers. None of the head cushions consistently demonstrated a larger surface area of pressure distribution. Conclusions: The medium-sized static air seat cushion, placed under the shoulders and head, demonstrated the most favorable pressure redistribution properties. The non-powered fluidized positioner demonstrated the least favorable pressure redistribution properties.
Background. Peristomal skin complications are frequent in ostomy patients, mostly occurring as a result of effluent leaking from the system. Accurate selection of ostomy products prevents complication onset, but still largely relies on the subjective evaluation of professionals. Purpose. To evaluate the functionality of a tool conceived to help practitioners objectively identify the most appropriate ostomy system based on patient characteristics. Methods. Professionals completed a dedicated questionnaire focused on new ostomy surgeries and changes in the abdominal profile and ostomy characteristics after 30 days from prescription. Results. The questionnaires supported a high functionality of the tool; the pouching system chosen immediately after intervention was largely confirmed (911/959 = 95% of cases; P < .001) also in the short-term. System revision was needed only in few cases (48/959 = 5%) and mostly after ileostomy (27/959 = 2.82% of total cases), even though confirmation did not significantly vary depending on intervention (P = .1). Conclusions. The tool can help practitioners in selecting the most adequate ostomy product(s), thus preventing postsurgical complications due to effluent leakage from the stoma and improving patients’ quality of life.
Background: New research is crucial in addressing the role of nurses in preventing pressure injuries (PIs) and remedying deficiencies in their self-efficacy in this area. Purpose: The aim of this study was to examine the self-efficacy perceptions of nurses in managing PIs within surgical services. Methods: The study involved 186 nurses from surgical services. Data were collected using a self-efficacy scale and a personal information form designed to assess nurses' PI management skills. Analysis involved descriptive (number, percentile) and inferential statistics (ANOVA, t- s) in SPSS-24. Results: Surgical nurses reported their self-efficacy in managing PIs with a mean score of 47.38 ± 21.87 on a self-efficacy scale, indicating a broad range of perceptions. Average scores were 43.55 ± 23.47 for evaluation, 48.39 ± 25.65 for planning, 43.68 ± 25.34 for surveillance, and 50.64 ± 22.23 for decision-making. Of note, nurses reported the lowest self-efficacy scores for evaluation. No significant differences were found based on employment duration, gender, or education. Significant differences were observed based on age, service level, and post-graduate education (P < .05). Conclusion: This study highlights the need for enhanced nurse self-efficacy in PI management in surgical services, emphasizing the role of education programs focused on evaluation skills.
Background: Peristomal skin complications (PSCs) are the most common complication among patients with ostomies after ostomy creation. Purpose: This systematic review and meta-analysis aimed to evaluate the factors influencing the occurrence of peristomal skin complications. Methods: A systematic review was conducted across multiple databases by using a combination of subject terms and free words for online search. The databases were searched from their inception to October 31, 2023. All studies that met inclusion criteria were examined to identify risk factors for PSCs. Two researchers independently conducted literature screening and information extraction, evaluated the literature quality using the Newcastle-Ottawa Scale, and performed descriptive analysis of the results. Results: Ten studies were included in this review. A total of 3753 patients with ostomies participated in the studies, and 981 patients suffered from PSCs, with PSC incidence ranging from 15.5% to 47.7%. Type of ostomy, diabetes, self-care knowledge, and chemotherapy were significant factors associated with PSCs. Conclusion: This review highlighted 4 factors that influence the occurrence of peristomal skin complications. The quality of included literature is generally low, with significant heterogeneity in study design and choice of outcome indicators. Therefore, further research involving high-quality studies with larger sample sizes is needed for deeper investigation.
Purpose: The aim of this study was to explore the clinical efficacy of vacuum sealing drainage in combination with silver-containing dressings for the treatment of chronic refractory wounds. Methods: In this retrospective study, 80 patients with chronic refractory wounds who were treated in the hospital were retrospectively selected as the study objects. Based on the treatment modalities, the patients were divided into the study group (SG; n=40, receiving vacuum sealing drainage combined with silver-containing dressings) and the control group (CG; n = 40, receiving vacuum sealing drainage alone). Results: The total effective rate of the SG was 92.5%, significantly higher than the 75% in the CG. After treatment, the SG exhibited lower positive rates in bacterial culture, as well as decreased levels of C-reactive protein and erythrocyte sedimentation rate compared to the CG. Starting from the sixth day of treatment, the SG reported statistically significant lower pain intensity scores than the CG. Additionally, the SG exhibited significantly lower dimension scores in terms of scar thickness, color, tenderness, and vascular distribution compared to the CG. Conclusion: The combined application of vacuum sealing drainage and silver-containing dressings demonstrated a positive treatment efficacy for patients with chronic refractory wounds.
Background: Pressure injury (PI) is a significant health concern among older inpatients, particularly in regions with diverse ethnic populations. Understanding the epidemiological characteristics and preventive measures is crucial for improving patient outcomes. Purpose: To analyze the epidemiological characteristics, prevention status, and influencing factors of pressure injury (PI) in older inpatients of Zhuang and Han nationality in Guangxi, China. Methods: A total of 2206 inpatients age 60 years or older in 2 class III grade A general hospitals in the Guangxi Zhuang Autonomous Region between April 1, 2021, and May 27, 2021, were included in this cross-sectional study. Epidemiological characteristics—including age, sex, educational background, race, ethnicity, and hospitalization information—were collected using a general information questionnaire designed by the researchers. The PI risk factors were evaluated using the Braden Scale. Prevention status was assessed using the Epidemiology and Prevention Skin Injuries in the Elderly Scale and Skin Injury Survey Scale. Results: Of the total 2206 patients included in the study, 555 (25.16%) were of Zhuang nationality and 1651 (74.84%) were of Han nationality. The overall PI incidence was 2.58%, with PI prevalence of 1.80% and 2.85% in Zhuang and Han patients, respectively. The main influencing factor for PI in Zhuang patients was caregivers (P < .05), whereas in Han patients the main influencing factors were urinary conditions, Alzheimer disease, sedatives, and antihypertensive drugs (P < .05). Conclusion: The PI prevalence rates were similar in both ethnic groups. Health care staff in high-risk departments for PI must remain vigilant and take appropriate action.
Background: Stoma creation is standard in general surgery, yet complication rates remain high. Purpose: This study investigated the incidence and risk factors for early postoperative stoma complications in elective vs emergency surgery. Methods: All patients who underwent stoma creation between June 2015 and November 2020 were retrospectively reviewed and analyzed. Patients were divided into 2 groups based on the surgery type: elective vs emergency. Results: A total of 375 patients were included in this study. Two hundred fifty-three patients (67.5%) underwent elective stoma creation, while 122 (32.5%) underwent stoma creation during an emergency surgery. In the emergency group, white blood cell, blood urea nitrogen, and creatinine levels were statistically significantly higher (P = .001, .001, and .002, respectively). Albumin levels were statistically significantly lower in the emergency group (P = .001). The mean Emergency Surgery Score was 5.17 ± 2.73 in the emergency group compared to 4.4 ± 2.44 in the elective group (P = .006). Colorectal cancer was the most common cause of stoma creation in both groups. In terms of stoma creation, colostomy was statistically significantly more common in the emergency group (59%, P = .001), compared to ileostomy in the elective group (58.9%, P = .001). Complications were observed in 135 of all patients (36%). Necrosis was statistically significantly more common in emergency cases (9.9%, P < .001). Conclusion: Surgeons should strive to optimize the patient’s condition prior to the operation and, if possible, perform stoma marking or involve a stoma nurse in the operating room to select the most suitable site. In high-risk patients, where complications are more likely, the use of a stoma should be minimized and definitive management should always be pursued if feasible.
Background：This study reports experience of wound care at the site of cannulation in the case of a patient with dilated cardiomyopathy (DCM) weaned from extracorporeal membrane oxygenation (ECMO). Purpose: To describe the use of a self-made vacuum-sealing drainage device with constant-temperature flushing to manage wound exudates in the cannulation site, aiming to create an environment conducive to wound healing. Materials and Methods: Exudates from the wound were processed using the vacuum-sealing drainage technique combined with constant-temperature flushing. Anti-infective agents were systemically administered to control infection and promote wound healing. Additionally, the patient’s nutritional status, pain management, psychological well-being, and rehabilitation were assessed and managed as part of the comprehensive care approach. Results: The wound exhibited gradual healing under this multifaceted care strategy. After 48 days of treatment, the patient demonstrated stable disease conditions and achieved wound closure. The patient was subsequently transferred to a general ward for further care. Conclusion: The use of a self-made vacuum-sealing drainage device with constant-temperature flushing, along with comprehensive patient management, proved effective in wound care for a critically ill patient with ECMO cannulation. This approach fosters an optimal environment for wound healing and contributes to patient recovery and stability.
Background: Aberrant tissue repair can result in the formation of chronic wounds and pathological scarring, which can severely impact a patient’s quality of life. Due to their complexity, treatment of these conditions remains challenging. Purpose: This review article provides a brief overview of the various treatments with regards to application, possible mechanism(s) of action, new developments, and areas requiring further research. Methods: A literature review on the different therapies/products currently used for chronic wounds and pathological scars was conducted. Several databases—including PubMed, ScienceDirect, Web of Science, and Google Scholar—were searched to find relevant articles on this topic. Results: Numerous products and treatment options, including several promising new technologies, are currently available. These therapies/products aim to accelerate wound healing, reduce scarring, and ultimately reach the goal of scarless tissue regeneration. Conclusion: Currently, no gold standard therapy exists for chronic wounds and pathological scars. Existing treatments demonstrate varying levels of efficacy, and further research is required regarding their safety and molecular mechanism(s) of action.
Background: There are no scales used by stoma and wound care nurses to evaluate the stoma care skills of individuals with a urostomy. Purpose: This study was conducted to investigate the Turkish validity and reliability of the Urostomy Education Scale (UES). Methods: The study sample consisted of 66 patients who had undergone radical cystectomy, were in the 0- to 7-day postoperative period, were older than 18 years of age, had no physical or mental disabilities, had no urostomy complications, and agreed to participate in the study. This study used translation and back-translation to determine the linguistic validity of the UES in Türkiye. Expert opinion was consulted for content validity. Then, 2 competent and 2 experienced nurses evaluated the face validity of the scale with 5 individuals with urostomies. Reliability of the scale was assessed using internal consistency, interrater reliability, and intraclass correlation coefficients. Results: The content validity index was 0.81 and α = 0.66 to 0.95 for the Cronbach’s alpha of the competent nurse assessment and α = 0.68 to 0.96 in the expert nurse assessment. The intraclass correlation coefficient (ICC) results indicated sufficient and statistically significant agreement (ICC range: 0.6-1) between the evaluations made by the 2 evaluators for each skill. Conclusion: The Turkish version of the 7-item UES is a valid and reliable tool that can be used to determine the self-care levels of individuals with a urostomy.
Background: Negative pressure wound therapy (NPWT) promotes wound sterilization, improves tissue granulation, and ensures appropriate wound healing. Its potential in contaminated abdominal procedures is still under study, but the results are promising. Purpose: This research provides insight into the use of NPWT for the effective preparation of laparotomy wounds in close proximity to ostomies. It also demonstrates the application of NPWT systems for successful skin graft take under these conditions. Methods: The authors describe 3 cases in the burn unit of an academic hospital in the northeastern United States treated successfully with a combination of NPWT and skin grafting to manage open abdominal laparotomy wounds in close proximity to ostomies. Results: NPWT improved skin graft survival by promoting the creation of a clean base, which is important for ensuring appropriate skin graft take, and strengthening the bond between the graft and the recipient wound bed. Conclusion: Despite these successful results, evidence in this area is still mixed and would benefit from further studies in the field.
Background: Older patients with diabetes have behaviors and practices in foot care that differ from those of younger patients. There is a need for a tool to assess the foot care of patients with diabetes who are over the age of 65 years. Purpose: This study aimed to assess the validity and reliability of the long and short versions of the Foot Care Scale for Older Diabetics (FCS-OD) in Turkish society. Methods: A total of 172 older patients with diabetes participated in the study. Language validity, content validity, construct validity, Cronbach’s alpha coefficient value, item-scale correlations, parallel form reliability, and test-retest correlations were used to assess the Turkish version of FCS-OD. A patient identification form, FCS-OD, Diabetic Foot Care Self-Efficacy Scale, and Foot Self-Care Behavior Scale were used for data collection. Results: Turkish versions of the FCS-OD, both short and long versions, were at acceptable levels regarding their content (content validity index: 0.964, 0.975) and construct (factor loadings > 0.4). Both versions of the scale showed a high level of internal consistency as demonstrated by Cronbach’s alpha values (short version, 0.802; long version, 0.905) and item-scale correlations (> 0.3). Both versions of the scale were stable over time and compared to the parallel forms. Conclusions: Both versions of the scale were found to be valid and reliable for Turkish society with regard to psychometric properties.
