Objective: Lower extremity ulcers are caused by multiple disease processes and contribute to a high level of patient morbidity and health-care spending in the US. Negative pressure wound therapy (NPWT) has been used extensively for wound bed preparation. Our aim is to assess the efficacy of an affordable, low-profile single-use NPWT (single-use NPWT) on chronic lower extremity wounds that would usually be deemed too small or superficial for traditional NPWT. Method: A prospective pilot study was undertaken in which chronic lower extremity wounds were treated with single-use NPWT. Study visits were biweekly for primary contact dressing change, with the negative pressure unit being changed weekly. Biweekly assessments were made of wound appearance, surface area, depth, exudate amount, peri-wound skin integrity, and signs of clinical infection. Digital photography was performed at each visit. Patients with venous leg ulcers (VLUs) were treated with a 3-layer wrap. Diabetic foot ulcers (DFUs) were treated with off-loading shoes. Results: The study recruited 12 patients. There were 13 wounds in total; two DFUs, two traumatic/postoperative/pressure ulcers, and nine VLUs. DFUs decreased in size on average 62%, VLUs by 32%, and traumatic/postoperative/pressure wounds by 74%. The wound appearance became more favourable and the wound depth decreased with the use of single-use NPWT. Conclusion: Single-use NPWT is a suitable therapy for chronic lower extremity wounds. Single-use NPWT led to a decrease in wound size and depth, an increased amount of granulation tissue, and a high level of patient satisfaction, with a low complication rate. Declaration of interest: This study was funded by Smith & Nephew, Hull, UK. JC Lantis is a paid consultant for KCI, Smith & Nephew, Healthpoint and Macrocure. C Gendics is a paid consultant for Macrocure and ManukaMed.
It is commonly believed that sharp surgical debridement provides adequate bacteria control for local wound beds, despite limited supporting scientific evidence. We undertook a prospective study to evaluate the reduction in planktonic bacteria pre- and post-operative debridement in critically colonised wounds.Twelve patients, corresponding to 14 wounds, underwent debridement with either hydrodebridement or sharp steel debridement with pulse irrigation. Wound quantitative tissue cultures were taken pre- and post-debridement. There was no significant difference in wound aetiology or surface area between the two groups.TThe bacterial counts before debridement were 1×107 colony-forming units per gram (CFU/g) in the hydrodebridement group vs 1.4×107 CFU/g in the sharp debridement group; and 2.5×106 CFU/g (hydrodebridement) vs 7.5×105 CFU/g (sharp) after debridement (p=0.41). The total bacteria reduction was 7.5×106 CFU/g after hydrodebridement vs 1.3×107 CFU/g after sharp steel debridement (p=0.37). The mean percentage of bacteria killed from baseline was 75% by hydrodebridement and 93% killed by sharp debridement (p<0.05).Extensive operative debridement using either modality does not provide adequate immediate reduction in wound planktonic bioburden. However, all wounds appeared clinically appropriate for closure after debridement and postoperative antibacterial therapy. Postoperative antibacterial therapy may be imperative in cases of critically colonised wounds to achieve good outcomes.The senior author receives research grant support from Healthpoint Biotherapeutics; KCI; Manuka Honey; Smith & Nephew; Medline Ind., Macrocure; CODA. In addition the senior author is a consultant for: Smith & Nephew and KCI and medical consultant and reviewer for Macrocure. While the study as presented evaluates in part the efficacy of a commercial product from Smith & Nephew, no industry support for this study was sought or provided.
Surgical site infections (SSI) are a known complication of surgery. Silver-containing wound treatments are popular, despite the lack of evidence of SSI reduction. A two-armed study was conducted between July 2007 and November 2008 to evaluate the efficacy and ease of use of a postoperative silver dressing. In the first arm of the study, patients undergoing clean general, vascular, orthopedic, and neurosurgical procedures were allocated to receive a postoperative silver dressing (POSD) or a standard dressing of nonstick gauze under a fluid occlusive dressing. Outcome variables included the incidence of antibiotic initiation for SSI, clinical signs of infection, and leukocyte counts. The second arm of the study was a prospective case series designed to evaluate the performance and handling characteristics of the POSD. Onehundred- ninety-nine (199) patients (mean age 59.2 [range 21-94] years) were enrolled in the first arm of the study. Three out of 99 (3%) patients in the POSD and six out of 100 (6%) control group patients received antibiotic therapy for SSI (P = 0.498). Differences in the percentage of patients with clinical signs of infection following surgery also were not statistically significant (POSD: n = 24, 24.2%; control: n = 30, 30%; P = 0.426). In the second arm, 34 out of 36 patients rated the study dressing easy to apply in (94%), and no pain on removal was noted in 38 out of 57 (66.7%) assessments. No patients in the dressing performance cohort developed an SSI. Prospective, randomized, controlled clinical studies with large sample sizes are warranted to evaluate the efficacy and cost-effectiveness of the POSD.
Objectives: Peripheral vascular disease (PVD) is a systemic disorder, which can affect all territories of arteries. In order to maximize screening survey yield: we aimed to describe the association between positive lower extremity (LE) non-invasive flow studies in symptomatic patients and occult carotid occlusive disease (COD). Methods: A retrospective chart review was performed on 420 patients who underwent carotid duplex ultrasound and non-invasive flow studies (NIFS; aka Pulse volume recordings) for evaluation of COD and LE PVD respectively. Additional clinical variables collected included age, gender, and indication for NIFS and indication for carotid duplex. The respective studies were performed within a year of each other. Statistical analysis was performed using SPSSv20 software and SAS statistical software. Univariate analysis was performed using Mann-Whitney, student t-test and receiver operating curve (ROC). Results: 66% (266/420) of the patients were male and 43% (181/420) of patients had documented history of bruit. Patients with mild PVD (ABI between 0.81 and 1) were more likely to have clinically significant COD than patients with moderate to severe PVD (ABI < 0.8) (25% vs 16.19%, P=0.03). Therefore, severity of peripheral vascular disease did not correlate with likelihood of clinically significant COD (p>0.05). ROC analysis was performed (AUC=0.602, p=0.05). Low ABI 0.50 was found to be 92% sensitive (Se) but only 14% specific (Sp). The optimal ABI cutoff point for predicting COD was 0.95 (Se=40%,Sp 60%, Youden’s index 0.194) Conclusion: Therefore, routine screening for COD in patients with lower extremity peripheral vascular disease is unlikely to uncover clinically significant carotid stenosis. These findings do not indicate a population of patients for which a combined prospective screening is warranted.
