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Last updated: August 2005
Revision: 1.0

2011 - June

Surgical Dressings & Wound Management

By Dr. Stephen Thomas

Dr. Stephen Thomas has given a gift to the wound care community.  This is a tome that every serious wound care clinician should have on his/her reference shelf.

Covering all aspects of wound care dressings, this comprehensive textbook is really a must-have for anyone involved with dressings – from healthcare providers to manufacturers to sales reps to purchasing agents and insurers.

Drawing on over thirty-five years of experience in the field, Dr. Thomas was the Director of the Surgical Materials Testing Laboratory, a leading European center for testing surgical dressings and medical devices located in Cardiff, Wales in the United Kingdom.  Dr. Thomas has drawn on his numerous publications, including articles and books, to produce this definitive text.

Surgical Dressings and Wound Management is 708 pages and is divided into 23 sections, including a Buyer’s Guide and Index.  The Index is excellent and makes the book easy to use and navigate.  The first seven chapters can be read as a book and review basic, foundational information on wounds and wound care including:

        Chapter 1        Structure and Function of Skin

        Chapter 2        Classification of Wounds

        Chapter 3        Wounds: Counting the Cost

        Chapter 4        Mechanisms of Wound Healing

        Chapter 5        Wound Exudate

        Chapter 6        The Development of Dressings

        Chapter 7        Laboratory Testing of Surgical Dressings

Thomas’ introductory chapters are sprinkled with insights and wisdom gleaned from his vast wound care experience.  Here are two examples:

On exudate management:

Exudate management remains an art which is largely based upon some poorly understood science.  Like most skills it requires practice and experience to achieve an acceptable level of competence but it should never be forgotten that the patient is the individual who is paying for the practitioner’s education.  (page 55)

On a definition of the ideal dressing:

The ideal dressing or dressing system provides an environment within the wound in which the objectives of the current phase of treatment may be achieved in a timely and cost effective manner without compromising either the patient’s safety or quality of life, or adversely affecting the integrity of the periwound skin or the final cosmetic appearance of the healed wound where this is relevant.  (page 73).

Starting with Chapter 8, each section addresses one category of dressings, such as film dressings, foam dressings, hydrocolloid dressings and so on.  All major categories are covered, as well as some unusual categories such as Honey and Sugar Dressings (Chapter 15) and Maggot Therapy (Chapter 19).  In the late 1990s Dr. Thomas was responsible for introducing maggot therapy into Europe and played a significant role in getting this technique adopted into mainstream wound management.  Each of the category chapters reviews the history of the development of the dressing, classifications including properties/performance parameters, clinical experience with the dressings and related research and an extensive reference list.

Given the current popularity and increased use of certain dressings and devices, readers should pay special attention to the following chapters:

        Chapter 16        Silver Dressings

        Chapter 17        Odor Controlling Dressings

        Chapter 20        Negative Pressure Wound Therapy

Chapter 22 presents a framework for Dressing Selection based on wound characteristics.  This is a new spin on the old Red-Yellow-Black model and offers clinicians an updated and more sophisticated approach for clinical practice including:

        Black necrotic wounds

        Yellow sloughy wounds

        Red granulating wounds

        Pink epithelializing wounds

        Malignant wounds

        Infected wounds

As Dr. Thomas so correctly states in his Preface, “The production of this book represents the culmination of a working lifetime spent testing and evaluating surgical dressings and allied materials (with a few years off for maggot production).” How generous of Dr. Thomas to share his knowledge and experience with the international wound care community by writing this tome.

Surgical Dressings and Wound Management by Stephen Thomas – Your source for essential evidence-based information about surgical dressings and wound management.

Dr. Diane L. Krasner PhD RN CWCN CWS MAPWCA FAAN

dlkrasner@aol.com

2005 - August

Wound Care Practice

Edited by Paul Sheffield, Adrianne Smith and Caroline Fife

This handsome tome sets out to offer a comprehensive guide to the assessment and management of chronic wounds, and there is certainly plenty of information in its 800-plus pages. These are divided into five sections: The Problem Wound, Principles of Wound Assessment, Principles of Wound Management, followed by a catch-all section titled Pain, Infection & Adjunctive Therapies, with a final section on Healthcare Delivery.

The strength - and weakness - of the book is in its broad authorship. Sixty writers provide a wealth of perspectives, largely medical but with a scattering of other disciplines. Most offer the student and casual reader plenty to think about, well supported by discussion and references. But although it purports to be a reference book it is really a collection of monographs.

The problem is one of organisation. There is no real overview so topics overlap and feature in various different chapters. Even within sections, logic is a little lacking. To be useful for practitioners (and the student in a hurry), the information needs to be much more accessible.

Let us take one theme close to my heart, infection. There are sections in many chapters, many of which do not appear in the index, but only three chapters are dedicated to the topic: Skin, Skin Structure and Muscle Infections; Post-Operative Surgical Site Infections and Non-Necrotizing Skin and Soft Tissue Infections; and Infection Control in the Wound Care Setting.

The first of these has little to say on the skin but does provide a useful review of cellulitis and other soft tissue infections, including a useful table on the differential diagnosis of necrotising infections.

The second is a welcome diversion to acute surgery, hardly mentioned elsewhere, but is very superficial. Tragically, this chapter mentions MRSA just once and the section on the prevention of surgical site infection largely ignores all environmental considerations apart from a short paragraph on hand hygiene.

The third starts with Semmelweis and zooms around the world of infection control in 12 pages, the two paragraphs devoted to MRSA probably being in proportion.

There is no way to match assessment, management and wound dressings where infection is an issue, and the paucity of cross-references and limited index are serious concerns.

This text contains a wealth of knowledge and you’ll learn much if you simply dive in and read a bit. What you cannot do is use it as a reference book or hope to read it all. But if you are writing an essay on one particular topic or are involved in a local project focusing on one area, then this book will offer you an interesting background and refresher, providing food for thought and intelligent discussion.

There is a place in libraries and large departments for such works. This book is a fine collection of wound management monographs and, had it been marketed on that basis, would have got my vote. But as a textbook on wound care practice there are many better volumes around.

Andrew Heenan, RGN, RMN, BA (Hons), Staff Nurse, Surgery, St. Thomas’ Hospital, London; Editor, RealNurse.Net

andrew4@heenan.net

2005 - July

Formulary of Wound Management Products: A guide for healthcare staff

By DA Morgan

Now in it's ninth edition, the Formulary of Wound Management Products continues to offer all those involved in wound care access to a wealth of valuable information accompanied by supporting references. In fact, the title undervalues the guide. Far from simply providing an A-Z list of products, it also offers readers links to practical resources such as wound care groups, journals, guidelines and websites.

The author makes treatment recommendations in relation to wound types, a helpful addition perhaps for practitioners new to the field or those who do not have local protocols/policies available to them.

Both generic names, for example compression hosiery and low-adherent dressings, and brand names are described in the formulary, and Drug Tariff availability is indicated alongside each item. However, product sizes are listed for some items but not for others so future editions could benefit from a consistent approach in this respect.

The latter pages (coloured green) are dedicated to veterinary wound care, detailing both small animal and equine practice.

The author keeps the resource up to date by referring readers to the publishers website so they can download the latest additions/alterations to, or deletions from, the formulary.

With the abundance of dressings and treatment regimes being introduced into the tissue viability arena, this guide will prove essential reading for many.

Judy Harker, MSc, BNurs (Hons), DNCert, RGN, is Nurse Consultant, Tissue Viability, Pennine Acute Hospitals NHS Trust, Oldham, Lancashire, UK

judy.harker@pat.nhs.uk

2002 - August

Essential Wound Management for Day-to-Day Practice

Edited by Keith Harding and Judy Harker.

This is an educational resource file directed towards nurses working with patients who have ulcerated wounds. It comprises colour-coded sections which deal with all aspects of lower limb ulceration. The first section looks at diagnosis and documentation; two subsequent sections address prevention of infection and treatment of infected wounds and care of the diabetic ucler. A further three sections will be available from July 2002. Each section is written by a nationally recognised expert in the field of wound care and tissue viability, making the completed file a robust and effective up-to-date resource.

The file is user friendly, consisting of an A5 hardbacked ring binder in which each section can be inserted. Each section folds out in an easy to read visual format. The folder is small enough to keep in a community nurse's car or for ward nurses to keep handy on their desk.

The first section is divided into three clear parts: diagnosis; documentation; biology of healing. The introduction deals briefly with the causes of ulceration and highlights the importance of holistic assessment and safe practice. As an aid to diagnosis, the links between ulcer aetiology and physical symptoms are explained and illustrated by clear photographs. Typical medical histories of venous, ischaemic and mixed aetiology ulcers are offered which are concise and comprehensive.

The discussion on ABPI measurement is brief, suggesting that nurses reading this will already be familiar with the technique. However, the further reading list provides additional information for less experienced practitioners. Indeed, throughout the document, the reader is directed towards supplementary sources, including RCN guidelines and the internet, making this an ideal basis for developing PREP evidence.

The second part of this section is particularly useful, providing a clear guide to documentation. This can be a difficult issue for nurses, torn between writing too much information or not enough. Clear documentation is important for the nurse's own accountability and also for continuity of care when several professionals are involved in a patient's care. There are examples of good record keeping, illustrated by colour photographs. It contains a very useful section on anatomical landmarks, enabling the practitioner to record the precise position of the ulcer. Pitfalls in documentation are also highlighted, for example, the subjective use of descriptive levels of exudates, and solutions offered.

In the discussion on biology of healing, granulation and epithelisiation phases are illustrated, but not the inflammatory stage, although all three are described.

This resource file is sponsored by an educational grant from Unomedical. It is not surprising, therefore, that there is also a booklet contained in the pocket in the front of the folder which lists the Unomedical wound management dressing range. Each dressing is explained and indicative uses offered. The range comprises hydrogels, films, alginates and foams, but not hydrocolloids. There is also a section which contains a wound chart and various references and available dressing sizes, codes and FP10 availability, but not prices. The booklet is useful as a reference, but the nurse should be aware that other products are available and should use this in conjunction with their own trust's guidelines and policies.

To conclude, this resource file provides a concise, visual aide memoire for busy nurses. It would be useful for students as an introduction to lower limb ulceration and could form the basis for small group teaching sessions. It is also recommended that this guide be used as a record of evidence of PREP, provided that nurses work through each section and make use of the further reading and internet resources.

Jacqui Murray, RN Dip District Nurse, BA(Hons), BSc(Hons), CNS Tissue Viability, Senior Lecturer Practitioner, Tissue Viability and Leg Ulcer Management, Plymouth University, Plymouth, UK

jkmurray@plymouth.ac.uk



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