Author: Matilda Karlsson
Publisher: Linköping University Electronic Press
ISBN: 9175190087
Category :
Languages : en
Pages : 98
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Book Description
Background: Safe and effective wound dressing treatments are important for proper wound healing. Such procedures therefore need to be evidence-based regarding the most important outcome measures such as healing time, less discomfort for the patient, duration of hospital care and, importantly, less scarring. As the relation between longer healing times and more severe scarring is known, it is important to find dressing treatments that reduces such complications by providing fast and proper wound healing. In this thesis, four established wound dressing treatments (hydrofibre covered with film; porcine xenografts and polyurethane foam, with and without silver), were evaluated for two types of acute, partial thickness wounds: split thickness skin graft (STSG) donor sites and partial thickness burn wounds in two randomised, controlled clinical trials (RCT) with longterm scar follow ups. The relations between factors thought to influence wound healing and scarring as sex, infection, wound extent and depth, healing time and skin grafting were also investigated in these two wound models. Methods: Data from these trials were collected on sex, infection rates, wound depth and extent, need of skin grafting, healing times and scarring frequency together with demographic data. Scars were evaluated at 8 years in Study II and III and at 6 and 12 months after injury in Study V. Results: Two dressing treatments; hydrofibre covered with film and porcine xenografts gave significantly faster healing of the STSG donor sites than the standard of care (SOC) dressing, the polyurethane foam. The hydrofibre was thereafter implemented as the new SOC at the department. The long-term scar follow up showed that the hydrofibre group was most satisfied with their donor site scar, providing further evidence for the implementation of this dressing strategy. From the observer’s perspective no differences were found between these treatment groups. For partial thickness burns the treatment with a silvercontaining foam dressing showed significantly shorter healing time, whereas for the scars, no difference between dressing groups could be detected. A number of factors were identified that affected healing time: for donor sites only male sex was associated with shorter healing time. Sex was also the only factor that influenced donor site scarring, where female patients, both subjectively and objectively, were rated with higher scores (worse outcome). For partial thickness burns a larger extent of the burn wound, presence of deep dermal burns, and the need of skin grafting, all had a negative impact on both healing time and final scar. The final scar was also significantly affected by longer wound healing times and infection. Conclusion: The results suggest that the use of hydrofibre dressings covered with film on donor sites resulted in positive short-term and long-term outcomes. Regarding partial thickness burns, silver foam dressing resulted in faster healing but as for the final scar, no difference could be seen. Several factors were associated with longer healing times and more severe scarring such as: female sex, larger burns, deep dermal burns, skin grafting, and infection. Longer healing times were related to more severe scarring. Bakgrund: Säkra och effektiva förbandsbehandlingar är av stor klinisk betydelse. Därför behövs evidensbaserade sårbehandlingar med fokus på de viktigaste utfallen som läkningstid, minskning av patientens lidande, vårdtid och mindre ärrbildning. Eftersom förhållandet mellan längre läkningstid och mer allvarlig ärrbildning är känt är det viktigt att hitta sårbehandlingar som minskar komplikationer, ger snabb läkning av såret och acceptabla ärr. I denna avhandling utvärderades etablerade sårbehandlingar (hydrofiber täckt med film, xenotransplantat från gris och polyurethanskumsförband, med och utan silver), för två typer av akuta delhudskador; tagställen för delhudstransplantatet och dermala brännskador, i två randomiserade kontrollerade kliniska studier. Förhållandet mellan påverkansfaktorer såsom kön, infektion, sårdjup, såromfattning, läkningstid och hudtransplantation och utfall för läknings- och ärresultat har också undersökts. Metoder: Data för kön, infektionsfrekvens, sårdjup och omfattning, behov av hudtransplantat, läkningstid och ärrbildning från två randomiserade kontrollerade studier samlades in tillsammans med demografisk data. Ärren utvärderades efter 8 år i studie II och III samt vid 6 och 12 månader efter skada i studie V. Resultat: Två sårbehandlingar; hydrofiber täckt med film och xenotransplantat från gris visade signifikant snabbare reepitalisering av tagställen än standardförbandet (polyuretanskum). Hydrofibern implementerades som den nya standardbehandlingen på kliniken. Den långsiktiga ärruppföljningen avslöjade att gruppen med hydrofiber var den mest nöjda med sina tagställes-ärr, vilket gav ytterligare styrka till genomförandet av behandlingen. Ur observatörsperspektivet hittades inga skillnader mellan dessa grupper. För dermala brännskador gav behandlingen med silverinnehållande skumförband signifikant bättre läkningsresultat, för ärrbildning upptäcktes inte någon skillnad mellan grupperna. Ett antal faktorer som påverkade läkningstider identifierades; för tagställen gav endast manligt kön kortare läkningstider. Kön var också den enda faktorn som påverkade tagställets ärrresultat där kvinnor, både subjektivt och objektivt, bedömdes med högre poäng (sämre utfall). För dermala brännskador var det faktorer såsom en större omfattning av brännskadorna, närvaron av djupa dermala brännskador och behovet av hudtransplantation som hade negativ påverkan på både läkningstider och slutliga ärr-resultat. Det slutliga ärrutfallet påverkades också signifikant av längre läkningstider och infektion. Konklusion: Data tyder på att användningen av hydrofiber täckt med film på tagställen gav positiva resultat både på kort- och lång sikt. När det gäller förband för dermala brännskador resulterade silverskumförband i snabbare läkning men vad gäller ärr kunde ingen skillnad hittas. Flera faktorer var relaterade till längre läkningstider och mer ärrbildning som kvinnligt kön, större omfattning av brännskador, djupa dermala brännskador, hudtransplantation och infektion. Längre läkningstider var relaterat till mer allvarlig ärrbildning.
Author: C.T. Pham
Publisher:
ISBN: 9780909844752
Category : Skin
Languages : en
Pages : 101
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Book Description
Author: Robert Fitridge
Publisher: University of Adelaide Press
ISBN: 1922064009
Category : Medical
Languages : en
Pages : 589
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Book Description
New updated edition first published with Cambridge University Press. This new edition includes 29 chapters on topics as diverse as pathophysiology of atherosclerosis, vascular haemodynamics, haemostasis, thrombophilia and post-amputation pain syndromes.
Author: Melvin A. Shiffman
Publisher: Springer Nature
ISBN: 3030106985
Category : Medical
Languages : en
Pages : 495
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Book Description
This book addresses wound care in vascular surgery, neurosurgery and lower extremity ulcers, while also providing detailed information on the latest concepts in antimicrobial therapy. The book presents essential content on the assessment, care, measurement and repair of wounds, and describes important scientific aspects as well as current clinical techniques. Due to the various topics covered, the book offers a valuable resource not only for plastic surgeons, but also for neurosurgeons, vascular surgeons and all clinicians who are interested in learning about current antimicrobial agents and their use.
Author: Ruth Bryant
Publisher: Elsevier Health Sciences
ISBN: 0323316212
Category : Medical
Languages : en
Pages : 670
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Book Description
Prevent and manage wounds with this expert, all-inclusive resource! Acute & Chronic Wounds: Current Management Concepts, 5th Edition provides the latest diagnostic and treatment guidelines to help you provide quality care for patients with wounds. This textbook presents an interprofessional approach to maintaining skin integrity and managing the numerous types of skin damage including topics that range from the physiology of wound healing, general principles of wound management, vulnerable patient populations, management of percutaneous tubes, and specific care instructions to program development. Written by respected nursing educators Ruth Bryant and Denise Nix, this bestselling reference also provides excellent preparation for all wound certification exams. A comprehensive approach to the care of patients with acute and chronic wounds guides students and health care providers to design, deliver and evaluate quality skin and wound care in a systematic fashion; the comprehensive approach includes the latest advances in diagnosis, differentiation of wound types, nutrition, prevention, treatment, and pharmacology. Self-assessment questions and answers in each chapter help you assess your knowledge and prepare for all wound certification exams. Checklists offer a concise, easy-to-read summary of the steps needed to achieve the best patient care outcomes. Risk assessment scales help in determining a patient's risk for developing a wound, and wound classification tools identify the proper terminology to be used in documentation. Learning objectives at the beginning of each chapter focus your study on the most important content. Principles for practice development boost outcomes and productivity in agencies and institutions, home care, acute care, long-term care, and long-term acute care settings. NEW coverage includes the latest guidelines from WOCN, AAWC, NPUAP, EPUAP, and PPPIA, and the American College of Physicians. New sections cover the prevention and management of biofilm, the new skin tear classification system, MASD and MARCI, CTP terminology and classification scheme, and integration of the Health Belief Model. NEW! Additional full-color photographs show the differential diagnosis of types of skin damage, management of fistulas, and NPWT procedures. NEW! Clinical Consult features help in applying concepts to clinical practice, showing students and health care professionals how to assess, manage, and document real-life patient and staff encounters using the ADPIE framework. NEW two-color illustrations and design make the book more visually appealing.
Author: Erika Nyman
Publisher: Linköping University Electronic Press
ISBN: 9175191148
Category : Burns and scalds
Languages : en
Pages : 98
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Book Description
Every day and in all parts of the world, humans experience different grades of wounding and tissue loss of the skin, thus initiating one of the most complex biological processes. Acute and chronic wounds, as well as the additional problem of skin scarring, involve not only great suffering for the patient but also extensive health care costs for the society. Although the wound-healing process is a wellstudied field much knowledge must be gained to unlock the door to regenerative pathways in humans. Epidermis heals by complete regeneration, but dermal and full thickness injuries heal with fibrosis and scar formation. In Papers I and II, we studied whether dermal scarring could be turned into regeneration by using two different types of threedimensional dermal scaffolds. In Paper I, we studied a solid scaffold made of poly(urethane urea), initially in vitro then followed by in vivo studies. In Paper II, we intradermally injected a liquid three-dimensional scaffold consisting of porous gelatin spheres in human healthy volunteers. Both materials showed ingrowth of functional fibroblasts and blood vessels and appeared to stimulate regeneration while slowly degrading. This finding could be of significant clinical importance, for example in burn wound care or after cancer surgery. In Papers III and IV, we wanted to study the effects of amniotic fluid and hyaluronic acid on adult wound healing, because early fetal wounds re-epithelialize rapidly and naturally heal dermis by regeneration without the need of a dermal scaffold. Amniotic fluid, naturally rich in hyaluronic acid, induced an accelerated reepithelialization of adult human wounds in vitro, and hyaluronic acid seemed to be important for this effect. Stimulation with exogenous hyaluronic acid in vivo induced accelerated re-epithelialization and an altered protein expression in healthy human volunteers. The inflammatory phase of wound healing, as measured by tissue viability imaging, was not affected by hyaluronic acid. Elucidating the effects of amniotic fluid and hyaluronic acid on the wound-healing process may allow improved treatment of wounds with impaired healing. Studies on finding new dermal scaffolds and studies on the positive effect of amniotic fluid or hyaluronic acid on the wound-healing process are two different ways of gaining insight that may lead to regeneration and improved wound healing for the patient.
Author: Patrica A. Hebda
Publisher:
ISBN:
Category :
Languages : en
Pages : 103
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Book Description
The purpose of this study was evaluate dermal-epidermal interrelationships during wound repair by assessing the effect on wound healing factors derived from platelets. Two methods were used to approach the problem: 1) an in vitro epithelization model in which small sections of partial-thickness pig skin (explants) were grown in medium containing fetal bovine serum and/or a platelet homogenate or purified-thickness platelet-derived factors, a nd eipidermal cell outgrowth from the explants was measured; 2) a wound healing animal model in which partial-thickness on epidermal cells. Our conclusions are that platelet components stimulate epidermal cell viability and outgrowth in explant cultures. We recommend further exploration of these factors. The factors should be purified from platelets, compared with known growth factors, and evaluated first in vitro with epidermal explant and cell culture systems. Active factors should be tested alone and in combination in animal would healing trails. Finally, an effective treatment should be evaluated in a clinical study with human subjects for effects on acute wounds, burn wounds and chronic ulcers.
Author:
Publisher:
ISBN: 9780966038903
Category : Medical
Languages : en
Pages : 58
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Book Description
Author: Karen Hertz
Publisher: Springer
ISBN: 3319766813
Category : Medical
Languages : en
Pages : 169
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Book Description
This open access book aims to provide a comprehensive but practical overview of the knowledge required for the assessment and management of the older adult with or at risk of fragility fracture. It considers this from the perspectives of all of the settings in which this group of patients receive nursing care. Globally, a fragility fracture is estimated to occur every 3 seconds. This amounts to 25 000 fractures per day or 9 million per year. The financial costs are reported to be: 32 billion EUR per year in Europe and 20 billon USD in the United States. As the population of China ages, the cost of hip fracture care there is likely to reach 1.25 billion USD by 2020 and 265 billion by 2050 (International Osteoporosis Foundation 2016). Consequently, the need for nursing for patients with fragility fracture across the world is immense. Fragility fracture is one of the foremost challenges for health care providers, and the impact of each one of those expected 9 million hip fractures is significant pain, disability, reduced quality of life, loss of independence and decreased life expectancy. There is a need for coordinated, multi-disciplinary models of care for secondary fracture prevention based on the increasing evidence that such models make a difference. There is also a need to promote and facilitate high quality, evidence-based effective care to those who suffer a fragility fracture with a focus on the best outcomes for recovery, rehabilitation and secondary prevention of further fracture. The care community has to understand better the experience of fragility fracture from the perspective of the patient so that direct improvements in care can be based on the perspectives of the users. This book supports these needs by providing a comprehensive approach to nursing practice in fragility fracture care.
Author: Ruth A. Bryant
Publisher: Elsevier Health Sciences
ISBN: 0323069436
Category : Medical
Languages : en
Pages : 671
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Book Description
Rev. ed. of: Acute and chronic wounds / [edited by] Ruth A. Bryant, Denise P. Nix. 3rd ed. c2007.
