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A directory of articles published in World Wide Wounds, classified according to subject area.
Last updated: September 2009
Case report: The use of butter for a hot tar burn injury - Using butter to treat a hot tar burn injury - in this case report the authors describe how butter was used to quickly and effectively remove tar from a patient's hand following an accident at work. P Steenvoorde, J Duijff, Alex v/d Lecq.
Case report: complex neuropathic foot ulcer - K. Vowden, A. D'Arcy and P. Vowden provide a case study outlining the management of a chronic, non-healing ulcer, treated with a bioengineered skin product.
Cellular, molecular and biochemical differences in the pathophysiology of healing between acute wounds, chronic wounds and wounds in the aged - in this article, the authors discuss the differences in the environment and healing patterns of acute and chronic wounds, including the effects of ageing on healing, and highlight the need for meaningful alternative endpoints for use when assessing patients with chronic or non-healing wounds. S Enoch and P Price.
Management of a pilonidal sinus with V.A.C.® Therapy - This short paper reports on the successful treatment of a teenage patient with a pilonidal sinus and describes the use of vacuum assisted closure therapy. The advantages of changing German healthcare policy to allow this therapy to be used in outpatient and home-bsed care settings is also discussed.
Opinion: NICE - time for review? - Steve Thomas provides a personal view of the shortfalls of the recent NICE guidelines on the use of debriding agents for difficult to heal wounds.
Pain and wound healing - Ramon Pediani examines the role of pain control in surgical wound management.
Pattern of injury in motor vehicle accidents - Injuries from road traffic accidents are worsening each year. In this article the Douglas Bowley and Kenneth Boffard discuss the importance of recognizing the characteristic injury patterns associated with road traffic accidents and optimising care of severely injured patients.
Pilonidal Disease - David Miller and Keith Harding discuss the pathology, clinical presentations and appropriate management of pilonidal disease - a common complaint mainly affecting men from puberty to their mid thirties.
Sharp technique for wound debridement - David Leaper considers various wound debridement methods including sharp/surgical debridement to reduce the risk of complications and optimise wound healing.
Symptom control in the management of fungating wounds (part 1 of 2) - Wayne Naylor reviews the four most common symptoms associated with fungating wounds: exudate, malodour, bleeding and pain. Discussion of overall goals of care, together with methods used to control and/or eliminate these distressing wound related symptoms.
Symptom self-assessment in the management of fungating wounds (part 2 of 2) - Wayne Naylor focuses on the development of a new self-assessment tool to help evaluate the severity of symptoms and problems associated with fungating wounds, as well as the impact they have on the patient's quality of life.
The management of extravasation injury in neonates - Steve Thomas and colleagues describe a technique for the treatment of extravasation injuries in neonates, in which the affected area is covered with a sterile amorphous hydrogel enclosed in an impermeable plastic bag or sleeve.
The management of pain associated with dressing changes in patients with burns - This paper focuses on pain associated with dressing changes in burn patients. The need for accurate pain assessment is emphasised and the role of pharmacological and non-pharmacological methods of pain management are discussed.
The role of moist wound healing in the management of meningococcal skin lesions: a case study - Steve Thomas, Jennifer Humphries and Mair Fear-Price describe the management of haemorrhagic skin lesions in a patient with meningococcal meningitis.
The use of maggot therapy as an adjunct to surgical debridement: a paediatric case report - the authors describe a case in which maggot therapy was used as an adjunct to surgical debridement to cleanse an extensive post-traumatic amputation wound in a 10 year old boy.
Understanding fungating wound management - Patricia Grocott describes a research methodology and tool for evaluating dressing performance to help optimise palliative wound care.
Vacuum assisted closure (VAC) of wounds - Steve Thomas reviews the development and clinical experiences of using vacuum assisted closure, with clear recommendations and practical guidance on its day to day use in wound management.
Wound Bed Preparation - Kathryn and Peter Vowden explore the concept of wound bed preparation (WBP) as a treatment aim. This article focuses on the five main components of WBP and discusses the practical aspects of using a global framework of care.
Advanced treatments for non-healing chronic wounds - Advanced treatments for non-healing chronic wounds - the author reviews the latest developments in wound healing products.
Case series investigating the experience of pain in patients with chronic venous leg ulcers treated with a foam dressing releasing ibuprofen - This article describes the experiences of a group of patients with chronic venous leg ulcers being treated with a non-adhesive foam dressing releasing ibuprofen.
Extracellular matrix: review of its roles in acute and chronic wounds - the authors describe the role and function of the extracellular matrix, the largest component of normal skin, and the importance of re-establishing a functional ECM in chronic wounds to facilitate the healing process.
Integrating adjunctive therapy into practice: the importance of recognising 'hard-to-heal' wounds - This article discusses the importance of predicting which wounds are likely to be hard to heal. Increased understanding of the wound environment will provide opportunities to manipulate the wound bed to promote more rapid and potentially improved quality of healing for these patients.
Modern exudate management: a review of wound treatments - in this review, the author considers exudate from the perspectives of its nature, composition, assessment and the range of management strategies available.
Pain at wound dressing-related procedures: a template for assessment - the author presents a framework for assessing pain during dressing-related procedures, with downloadable templates for assessment and assessment rationale.
Should alternative endpoints be considered to evaluate outcomes in chronic recalcitrant wounds? - Alternative endpoints to healing - in this article, the authors debate the usage of 'complete wound closure' as the primary endpoint to assess the progress of chronic wounds and argue that alternative endpoints, either intermediate or surrogate, should be considered to evaluate their outcomes. S Enoch, P Price.
The cost of treating hard-to-heal venous leg ulcers: results from a Swedish survey - in this article the authors summarise results from a Swedish survey on the cost of venous leg ulceration and present the data on a subgroup of patients with large ulcers of long duration. They discuss the use of advanced treatment options for patients at increased risk of delayed healing and the possible health-economic benefits of this approach.
Wound healing complications associated with lower limb amputation - this paper describes a number of problems associated with amputation wound healing and highlights the importance of multidisciplinary team working.
A new topical antibiotic delivery system - Lawrence Kollenberg discusses a novel method of antibiotic delivery for infection in deep soft tissue and osteomyelitis infections of the feet.
A comparative study of the properties of twelve hydrocolloid dressings - Stephen Thomas and Philip Loveless report on a laboratory study comparing 12 hydrocolloid dressings.
A users guide to the selection of dressing - Steve Thomas discusses the factors which influence the selection and use of dressings for different types of wounds.
An evaluation of a new type of compression bandaging system - A laboratory-based study was undertaken to examine a new type of compression bandage. The results highlight the need to determine a safe upper limit for externally applied sustained compression and the importance of correct application in order to reduce the possibility of over compression.
Atraumatic dressings - Steve Thomas discusses the causes of traumatic injuries associated with the removal of dressings and proposes that the term 'atraumatic dressings' be adopted to describe products that do not cause such problems in clinical practice. The article also contains a review of the literature relating to a new category of dressings which rely on soft silicone technology and could reasonably be described as 'atraumatic dressings'.
Bandages on the Drug Tariff - Andrew Heenan outlines bandages available on the Drug Tariff.
Comparison of foam and hydrocolloid dressings in the management of wounds: a review of the published literature - Appropriate dressing selection plays a key role in promoting and maintaining a wound environment that is conducive to healing. A wide range of modern products is available to clinicians. The objective of this study was to compare the clinical performances of the two most commonly used dressing types (foams and hydrocolloids) by means of a literature review.
Compression bandaging in the treatment of venous leg ulcers - Steve Thomas explains the classification of bandages, and outlines how to choose an appropriate product.
Dressings and bandages on the Drug Tariff - This set of five articles has been produced to reflect information available in the Drug Tariff and cover alginates, absorbent dressings and primary dressings, bandages, hydrocolloids and vapour-permeable dressings. A Heenan.
Four-layer bandaging: from concept to practice. Part 1: The development of the four-layer system - Four-layer bandaging from concept to practice - this is the first article in a short series looking at the development of the four-layer system and current understanding of the mechanisms of action of compression. C Moffatt.
Four-layer bandaging: from concept to practice. Part 2: The development of the four-layer system - Four-layer bandaging from concept to practice - the second article in a short series on four-layer compression bandaging. This article looks at the clinical indications for use and how to apply a four-layer bandage.
Frequently asked questions: Alginate dressings - all you want to know about alginates.
Frequently asked questions: Hydrocolloid Dressings - all you want know about hydrocolloids.
MRSA and the use of silver dressings: overcoming bacterial resistance - MRSA and the use of silver dressings - in this seminal article Steve Thomas addresses many of the issues surrounding the management of MRSA, with the focus on the role of topical products and the potential value of silver-containing dressings. S Thomas.
Moisture-related skin damage and the role of dressings - This article describes the importance of controlling the moisture content of wounds and areas of vulnerable tissue, with particular emphasis on the use of dressings that provide protection to periwound skin. The author also proposes a new definition for the 'ideal dressing', which takes account of the need to protect vulnerable tissue from secondary damage caused either by insufficient or excessive moisture.
Next generation products for wound management - In this review Joanne Stewart discusses the novel technologies that are being developed to improve healing in difficult to heal wounds and highlights the importance of controlled clinical studies to test the effectiveness of these products.
Odour absorbing dressings: a comparative laboratory study - Steve Thomas and colleagues describe a new method of assessing the performance of odour absorbing dressings.
Setting up wound dressing guidelines: avoiding the pitfalls - David Morgan guides us through the maze of producing wound dressing guidelines.
Soft silicone dressings: frequently asked questions - Soft silicone dressings - all you want to know about hydrocolloids.
The development of a novel technique for predicting the exudate handling properties of modern wound dressings - Steve Thomas and Paul Fram describe the development of a new wound model for measuring the absorbency of wound dressings. Historical background and preliminary results are given.
The use of the Laplace equation in the calculation of sub-bandage pressure - In this article, Steve Thomas illustrates how Laplace's equation can be used to predict sub-bandage pressure in the clinical setting, which takes into account the factors of bandage width, the numbers of layers applied and method of application. S Thomas.
Wound dressings on the Drug Tariff - Andrew Heenan outlines wound management products available on the Drug Tariff.
An overview of surgical site infections: aetiology, incidence and risk factors - the authors describe the risk factors for surgical site infection and the tools used to identify and help prevent it.
Honey as a topical antibacterial agent for treatment of infected wounds - Peter Molan reviews the use of honey as a topical treatment for infected wounds with practical considerations for applying honey in the clinical setting.
Impact of bacterial communities and biofilms on wound healing - this article looks at bacterial communities and biofilms, which may have a significant effect on wound healing and infection. S Percival, P Bowler.
Review of the clinical RCT evidence and cost-effectiveness data of a sustained-release silver foam dressing in the healing of critically colonised wounds - in this paper the author reviews the clinical evidence of a sustained-release silver dressing when used for the treatment of critically colonised wounds. This is based on the results from a randomised controlled clinical trial, a real-life randomised comparative study from everyday practice and a health-economic evaluation.
Topical antimicrobial in wound care - This review gives an insight into the use of topical antimicrobial agents by describing their respective mechanisms of action, reviewing the evidence base and outlining perceived limitations. The author extends this review with a discussion on future topical treatment strategies for wound infection. R Cooper.
Wound Infection - Mark Collier describe the historical background, potential wound pathogens and the development of infection. The clinical signs and consequences of wound infection are described, together with the key principles for the management of a patient with a wound infection, with prevention being the primary management objective for all healthcare professionals.
Compression hosiery for venous leg ulcers - Sue Johnson reviews the purpose and function of compression hosiery, including patient assessment, measurement and compliance issues. Basic principles for successful management are also provided.
Doppler assessment and ABPI: interpretation in the management of leg ulceration - Peter and Kathryn Vowden discuss the relevance of ABPI, and the evidence relating to its pivotal position in leg ulcer management. A model for ABPI procedure using the Doppler method is provided, together with a useful reference chart for calculating ABPI.
Encouraging patient involvement in the management of lymphovenous leg ulceration: a case report - in this short case report the author describes how involving patients in their treatment and care is crucial to the maintenance of long-term improvements.
Four-layer bandaging: from concept to practice. Part 3: Evidence base for treating venous leg ulcers - This article, the third and final in a series reviewing four-layer bandaging, looks at the evidence base for efficacy in treating venous leg ulcers.
Leg ulceration: a complex case scenario - Christine Moffat describes a case scenario in which a patient is presented with recurrent venous leg ulceration. Effective care, involving the multidisciplinary team, is shown to dramatically improve outcome and patient quality of life.
Loss of self: a psychosocial study of the quality of life of adults with diabetic ulceration - In this paper the authors aim to raise awareness of psychosocial quality of life issues for patients living with diabetic foot ulceration. Using comments from the patients in the study, they reveal a range of resistrictions on daily life that affect the individual's 'sense of self'.
Motorised ankle dorsiflexion - the authors describe how a motorised pump may be used as an adjunctive treatment in the management of hard-to-heal venous leg ulcers. MC Garcia, KT Lund.
Negative Pressure Wound Therapy - Negative Pressure Wound Therapy (NPWT) also known as Topical Negative Pressure (TNP) was used for wound management in primary care. We studied time for ulcer healing, change of ulcer size and formation of granulation tissue.
A case history describing the use of sterile larvae in a malignant wound - Mary Jones and colleagues describe the use of larvae in the management of a squamous cell carcinoma.
Case report: maggot therapy in an acute burn - Daniel Thornton, Miles Berry and David Ralston present a challenging case in which maggots were used to good effect in a burn that was difficult to manage by conventional means.
Case study: Larval therapy for an infected insect bite - Rachel Chaffey explains the use of sterile larvae (maggots) in the management of an extensive leg ulcer that resulted from an infected insect bite.
Larval therapy: A review of clinical human and veterinary studies - a thought provoking review by Janet Hinshaw of larval therapy in humans and animals.
Management of a diabetic foot ulcer using larval therapy - Ann Knowles, Andrew Findlow, and Nicky Jackson present a case history illustrating the adverse effects of diabetes on feet and the successful management of a complex foot lesion using larval therapy.
Treatment of a deep injection abscess using sterile maggots in a donkey: a case report - This case report describes an ageing female donkey with a deep necrotic abscess who is successfully treated using sterile maggots.
A case of pyoderma gangrenosum successfully treated with intravenous immune globulin - Carlesimo, Cantisani and colleagues describe a patient with pyoderma gangrenosum resistant to conventional treatment, who was treated successfully with IVIG.
A review of the expert opinion on latex allergy - Pete Phillips reviews the report written by the European Commission group of experts into latex allergy and related issues.
Assessing and managing vulnerable periwound skin - This paper examines the factors that lead to or exacerbate the condition. Assessment, management and prevention of periwound skin problems are also discussed. It is the second of three papers on vulnerable periwound skin.
Assessing the patient with a skin condition - a guide for nurses assessing patients with a skin condition - Sandra Lawton has written a guide for nurses in assessing patients with a skin condition, to help understand the basic principles of skin disease and care.
Dermatological problems and periwound skin - In this short paper – the third in a series of three articles examining care of the skin surrounding wounds – the authors describe the common dermatological problems associated with the periwound skin of specific wound types.
Recent advances in the use of lasers in dermatology - Sean Lanigan, discusses advances in the treatment of port wine stains, tattoos and other skin lesions.
The pathophysiology of vulnerable skin - This is the first in a series of three articles examining the causes and consequences of vulnerable skin. This author describes the physiology of normal skin and examines the many factors and situations, both intrinsic and extrinsic, that contribute to vulnerable periwound skin.
Teaching wound management: a collaborative model for future education - in this article the author, a primary care tissue viability nurse, describes how a primary care health authority worked in partnership with a commercial company and a higher education institution to provide a new model of education using the concept of wound bed preparation and the TIME framework.
Leg ulceration: complex case scenario - Christine Moffatt describes a complex case scenario which reviews the case of a 40 year old woman who presented with bilateral foot and leg ulceration and numerous other medical problems. An overview of her management plan and and outcome of the case, with things to consider when planning an effective care programme in such patients.
Hyperbaric oxygen therapy for wound healing - James Wright reviews the medical use of oxygen under pressure (HBO2) and how it can help to heal problem wounds.
Focus on silver - This paper reviews the background to the rise in use of silver for wound care and the potential for emergent bacterial resistance to silver.
An overview of non-cancer related chronic oedema - a UK perspective - Anne Williams considers the pathophysiology underlying this complex condition. Its development provides many challenges for patients and healthcare professionals alike. Various management strategies are discussed that reflect the types of treatment and care required for different individuals.
Entonox for procedural pain relief - Nitrous oxide and oxgyen gas mixture (Entonox) has been available for many years and can be used to provide short-term pain relief and relaxation during painful procedures such as wound dressing changes. In this paper the author discusses the use of Entonox, outlines protocols for administration and the cautions that need to observed.
PERSONAL PERSPECTIVE: Psychology of pain and wound healing - Impact of mental activity on pain and wound healing - Professor Terence Ryan offers a personal perspective on the role of mental activity in patients with wounds. TJ Ryan.
A clinimetric analysis of wound measurement tools - In this article, the author analyses a number of different methods of measuring wounds to record relative changes in size over time using a clinimetric approach.
Automatic quantitative analysis of healing skin wounds using colour digital image processing - William Berriss and Stephen Sangwine review 'state of the art' computer assisted wound measurement.
Review of duplex and colour Doppler imaging of lower-limb arteries and veins - Michael Lunt outlines the principles of the different techniques of ultrasonic imaging and discusses procedures for investigating arterial stenoses, superficial venous incompetence and deep venous thrombosis.
A discourse on pressure ulcer physiology: the implications of repositioning and staging - the authors propose an alternative approach to the assessment and evaluation of pressure damage.
After TIME: wound bed preparation for pressure ulcers - the authors examine the concept of wound bed preparation and the assessment and treatment of pressure ulcers in the context of the TIME framework.
Morphological characteristics of the dermal papillae in the development of pressure sores - a study undertaken in Japan by Hiromi Arao and colleagues to clarify the morphological characteristics of the dermal papillae in the skin associated with pressure sores.
New guidelines for pressure ulcer management - Martyn Butcher presents a personal review of the recently published clinical guidelines from NICE on pressure ulcer risk assessment and prevention.
Obstetric care. Is there risk of pressure damage after epidural anaesthesia? - Caroline Hughes presents a review of the literature looking at the relationship between the use of epidural anaesthesia and the incidence of pressure damage to women during labour.
Preventing pressure ulcers in wheelchair users - in this 2-year prospective study, the authors explore the issues that predispose wheelchair users to the development of pressure ulcers. A longer-term objective is to develop a self-administered tool to be used by non-ambulant wheelchair users, their carers and health professionals. J Wall T Colley.
The art and science of evaluating patient support surfaces - Shyam Rithalia and Laurence Kenney discuss the limitations and need for cautious interpretation of current assessment techniques used to evaluate pressure relieving devices aimed at the prevention of pressure ulcers.
A review of the history of veterinary wound management - This review is based on the author's private literature collection and provides a fascinating insight into the history of treating animal wounds during the 17th, 18th and 19th centuries. From this is becomes clear that a number of principles have been established for centuries and are still in use today.
Management of a large flap wound to the beak of a mute swan (Cygnus olor): a case report - Glen Cousquer describes the presentation and management of a large flap wound to the beak of a young mute swan.
Management of saddle and harness sores in a pack mule on expedition – A case study - This case study will recount the experiences of a veterinary surgeon and Mountain Leader during a five day expedition through the Massif du Siroua, in the High Atlas of Morocco. The aetiology, prevention and management of saddle, harness and tethering sores will then be discussed in detail.
Management of territorial fight wounds in badgers - Glen Cousquer reviews the techniques currently used to manage fight wound in badgers and describes a method of treatment developed at the West Hatch Wildlife Hospital to promote rapid wound healing.
Post-hibernation management of rat bite injuries in a spur-thighed tortoise (Testudo graeca) - In this case report, Glen Cousquer describes the presentation and treatment of injuries caused by rat bites to the limbs, tail and shell of a tortoise following hibernation.
Veterinary care of a giant lop rabbit with severe fly strike - In this case report the author details the presentation, assessment and treatment of an obese two-year-old neutered male giant lop domestic rabbit (Oryctolagus cuniculus) with fly strike.
Wound assessment in the avian wildlife casualty - In the first part of this two-part article, the author emphasises the importance of accurate wound assessment in avian casualties and the need to adopt a systematic approach. Examples are taken from particular species-specific problems.
Wound management in the avian wildlife casualty - In Part 2 of this two-part article on avian wounds, the author discusses the management of a number of soft tissue injuries commonly seen in the avian wildlife casualty.