Ten top tips: Wound irrigation

Author: Joyce Black

Joyce Black is Professor, College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, US

Surgical incision care — negative pressure wound therapy and advanced dressings

This meeting report is based on the Mölnlycke-sponsored workshop held at the sixth World Union of Wound Healing Societies (WUWHS) Congress on March 1–5, 2022, in Abu Dhabi, United Arab Emirates. The workshop, titled ‘Surgical incision care — negative pressure wound therapy and advanced dressings: what to use and when’, included presentations from Kylie Sandy Hodgetts, Rhidian Morgan-Jones and Amit Gefen. The topics of surgical dressings, risk assessment and requirements of closed-incision negative pressure wound therapy (ciNPWT) were all explored.

Authors:

Rhidian Morgan-Jones (Chair), Amit Gefen and Kylie Sandy-Hodgetts

Rhidian Morgan-Jones (Chair) is Consultant Orthopaedic Surgeon, Cardiff Knee Clinic, University Hospital Llandough, Cardiff, UK; Amit Gefen is Professor of Biomedical Engineering and the Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel; Kylie Sandy-Hodgetts is Associate Professor, Centre of Molecular Medicine & Innovative Therapeutics, Murdoch University; Senior Research Fellow, Director Skin Integrity Research Institute, School of Biomedical Sciences, University of Western Australia, Perth, Australia.

Spina Bifida with foot deformity and a chronic non-healing ulcer in a 12-year-old boy: a case study

Abstract: Congenital dermal sinuses are a distinctive form of occult dysraphism where patients present with neurological compression, tethering, or meningitis. This is a case study of a child presenting with spina bifida with foot deformity and a chronic non-healing ulcer after excision of dermal sinus, and subsequent tethered cord due to arachnoiditis. He developed osteomyelitis and postoperatively, a non-healing ulcer, in an insensate foot. The patient was successfully managed, and complete wound healing was achieved within three months. A multidisciplinary approach to monitor, prevent and treat complications that may impact functionality, quality of life and survival of young patients with congenital dermal sinuses is needed.

Key words: ■ Congenital dermal sinus ■ Foot deformity ■ Insensate foot ■ Non-healing ulcer

Sunil V. Kari, Dr, MS, General Surgery, Sou. Mandakini Memorial Clinic, A unit of Mandakini Medi Engg Health Pvt Ltd, Bhagya plaza, NCM, Hubballi, India;

Vilasavati SS. Kanthi, Dr. MBBS, DCH, Sou. Mandakini Memorial Clinic, A unit of Mandakini Medi Engg Health Pvt Ltd, Bhagya plaza, NCM, Hubballi, India.

Review on use of platelet- rich plasma for wound care in medicare population

      Wound care management has continued to evolve and considering the Medicare population (ages 65 and above), the implications of management are significant. In the Medicare population, chronic wounds rank among the topmost reasons for seeking care. One sixth of Medicare patients are affected by chronic wounds which takes a major toll economically and medically (Nussbaum et al, 2018). Platelet rich plasma (PRP) is an important aspect of management due to its regenerative properties and its ability to accelerate healing. Some researchers have opined that PRP has the unique ability to completely heal wounds, however, research findings are conflicting with regards to the outcomes based on the types of wounds such as pressure ulcers and venous ulcers. PRP is a combination of thrombocytes, cytokines and multiple growth factors which include, but are not limited to, Platelet-Derived Growth Factor, Fibroblast Growth Factor, Insulin Growth Factor, Vascular Endothelial Growth Factor, Transforming Growth Factor-β, and Hepatocyte Growth Factor. Owing to the growing need and concern for PRP, especially in the area of regulation and consistency of outcomes of treatment, the authors have presented an overview of this modality of wound care in the older population.

Veronica C Nwagwu is Clinical Assistant Professor, Division of Geriatric and Palliative Medicine, University of Michigan Medical School; Certified Wound Care Specialist Physician, Cochair Wound Prevention and Management SIG- American Geriatrics Society (AGS); Theodore Suh is Professor of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Health System, Professor, GRECC Ann Arbor Veterans Affairs Hospital, US; Jerome Okudo is Researcher, Department of Public Health, University of Texas, Houston, Texas, US

Mupirocin ointment in the treatment of chronic non-healing wounds: a case series

Abstact: Mupirocin ointment (Supirocin ointment) is a topical antimicrobial that contains an active substance called mupirocin. It is used in adults, adolescents, children and infants aged ≥4 weeks to treat infections on the skin such as infected hair follicles that form pimples containing pus (folliculitis), skin infection with blistering and crusting (impetigo) or recurring boils (furunculosis). Mupirocin (pseudomonic acid A), derived from the common Gram-neagtive bacteria, Pseudomonas fluorescens, inhibits bacterial protein and RNA synthesis by binding to bacterial isoleucyl-tRNA synthetase. Once the formation of the isoleucyl-tRNA synthetase is blocked, the cellular levels of the isoleucine charged transfer RNA are depleted, stopping protein and RNA synthesis in bacteria. It is a potent inhibitor against Gram-positive skin flora such as coagulase-negative Staphylococci and Staphylococcus aureus. Its rapid systemic metabolism means it can only be used topically which, combined with its novel chemical structure, should make cross-resistance less likely to occur than with other currently available antibiotics. It is available as topical preparations only and has no oral derivative, providing a lower risk of resistance and, therefore, may be beneficial in wound care management.

Harikrishna KR Nair is a Professor and Head of Wound Care Unit, Department of Internal Medicine, Hospital Kuala Lumpur;

Wan Sakinah is a Medical Officer, Wound Care Unit, Department of Internal Medicine, Hospital Kuala Lumpur

Alina Md Isa is a Registered Staff Nurse, Wound Care Unit, Department of Internal Medicine, Hospital Kuala Lumpur

Key words: ■ Chronic wounds ■ Mupirocin ointment ■ Non-healing ■ Wound bed preparation ■ Wound care management

Efficacy of topical mupirocin versus 2% mupirocin in novel Cogen-S base in chronic skin ulcers: a pilot study

Aim: To compare the efficacy and safety of topical Mupimet (2% mupirocin in a novel Cogen-S base) against mupirocin alone in the management of skin ulcers. Methods: We conducted a randomised controlled trial (RCT) with patients suffering from skin ulcers of Wagner grading 1 or 2 for over 4 weeks. Both the medications were applied topically twice daily for 12 weeks. Ulcer area, wound size and wound infection score were assessed on a five-point scale. During this study period, treatment-emergent adverse reactions were not observed either by the investigators or by the patients. The results were expressed as mean± standard deviation values to imply the wound size of the foot ulcer from the baseline to the week 12.

Results: We recruited 50 patients, with 21 patients treated with mupirocin 2% and 24 patients treated with Mupimet ointment (five were lost to follow-up). We observed that the ulcer area was significantly reduced in the test groups (2% mupirocin in novel Cogen-S base) at 10 weeks, whereas the control group demonstrated a decrease in the wound size of over a period of 12 weeks. Statisical comparison using a t-test between two groups was conducted and showed statistical significance between the two groups in the study. When compared with the control value after 12 weeks, the test value is highly significant (p≤0.05 control and p≤0.05 test).

Conclusion: The wound healing effect of topical Mupimet (in Cogen-S base) with the antimicrobial effect of mupirocin toward the overall management of skin ulcers. The acceleration of wound healing is higher in combined form than mupirocin alone.

Key words: Chronic skin ulcer . Cogen-S .  Collagen .  Efficacy 2% Mupirocin .  Wound healing