An unexpected infection in a venous leg ulcer: a case report

Providencia rettgeri is a Gram-negative bacillus that is most usually seen in urinary tract infections. Skin and soft tissue infections with P rettgeri are rare and there few case reports described in the literature. A 43-year old woman presented to the emergency department with a leg ulcer of 3 months duration. Microbiological results isolated P rettgeri and Pseudomonas aeruginosa. She underwent surgical debridement and split-thickness skin grafting alongside IV antibiotic therapy and dressing care, with complete resolution of the wound 3 months after admission. The differential diagnosis of leg ulcers is wide and must include infection and venous insufficiency. Although venous ulcers are common, typically they are not responsible for rapid evolving ulcers that destroy tissues below the muscular fascia. In this case report, the authors hypothesise that P rettgeri had a major role in the severity of the ulcer in an otherwise healthy woman. A greater understanding of how P rettgeri affects wound pathophysiology is needed in order to distinguish between colonisation versus infection and discriminate bacterial synergy, as well as having better treatment guidelines.

Authors:

Miguel Veríssimo, Diogo Guimarães, Diogo Casal, Sara Carvalho, Miguel Matias, Raquel Barbosa and Joaquim Bexiga

Miguel Veríssimo is Resident. Diogo Guimarães is Resident. Diogo Casal is Attending Physician. Sara Carvalho is Attending Physician. Miguel Matias is Resident. Raquel Barbosa is Resident. Joaquim Bexiga is Attending Physician. All at Plastic Surgery Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.

Best Practice Statement Development of a wound care formulary using clinical evidence and ensuring effective change management

What makes a good formulary?

The importance of evidencebased practice

Considering cost

Change management

Addressing challenges and

measuring success

BEST PRACTICE STATEMENT: DEVELOPMENT OF A WOUND CARE FORMULARY USING CLINICAL EVIDENCE AND ENSURING EFFECTIVE CHANGE MANAGEMENT

PUBLISHED BY:

Wounds UK

A division of Omniamed Communications, 108 Cannon Street London EC4N 6EU, UK www.wounds-uk.com

This document has been developed by Wounds UK and is supported by an unrestricted educational grant from Urgo Medical.

This publication was coordinated by Wounds UK with the Expert Working Group and Review Panel. The views presented in this document are the work of the authors and do not necessarily

How to cite this document:

Wounds UK (2023) Best Practice Statement: Development of a wound care formulary using clinical evidence and ensuring effective change management. Wounds UK, London. Available to download from: www.woundsuk.com reflect the views of Urgo Medical.

EXPERT WORKING GROUP:

Jacqui Fletcher OBE (Chair), Independent Nurse Consultant

Andrew Sharpe, Advanced Podiatrist, Wound Care, Salford Care Organisation, Salford

Caroline Dowsett, Clinical Nurse Specialist, Tissue Viability Services, East London NHS Foundation Trust

David Wylie, Managing Director, DAWN Health & Care Consultancy UK Ltd; Honorary Fellow, Glasgow Caledonian University, Glasgow

Dawn Douglas, Community Matron, Northumbria Healthcare NHS Foundation Trust

Graham Bowen, Principal Podiatrist, Solent NHS Trust

Hollie Robinson, Tissue Viability Service Lead, South Warwickshire NHS Foundation Trust

Joy Tickle, Tissue Viability Nurse Consultant, Isle of Wight NHS Trust

Kelly Phillips, Skin Integrity Lead Nurse, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust

Leanne Atkin, Vascular Nurse Consultant, Mid Yorkshire NHS Trust; Research Fellow, University of Huddersfield

Michelle Goodeve, Senior Diabetes Specialist Podiatrist, Provide Community Interest Company

Nina Murphy, Operational Lead for Tissue Viability, North East London NHS Foundation Trust

Rebecca Elwell, Trustee, British Lymphology Society; Macmillan Lymphoedema ANP and Team Leader, University Hospitals of North Midlands NHS Trust

Sian Fumarola, Head of Clinical Procurement, North Midlands and Black Country NHS Procurement Group

Updates in the management of cardiovascular disease

Jane Diggle

Specialist Diabetes Nurse

Practitioner, West Yorkshire

Citation: Diggle J (2023) Updates in the management of cardiovascular disease. Diabetes & Primary Care 25: 145–7

Use of acellular fish skin grafts in wound healing: a literature review

Background: Ideally, a good skin graft substitute should be readily available, cost-effective, have a low disease transmission risk, reduce infection and scarring, and aid wound healing. Fish skin grafts (FSG) are an accessible option to most populations.

Aim: This literature review explores the use of FSG, as a xenograft, to aid in wound healing and the potential benefits or harms of using this intervention.

Methods: A literature search using the PICO method was conducted on MEDLINE, CINAHL Plus, Cochrane Library, Web of Science and Embase, and hand searched on the Cardiff University Library.

Results: FSG aided faster healing of burn wounds and reduced scarring. However, there was a lack of studies that examined the patient’s experience and the long-term effects of FSG.

Conclusions: FSG has multiple biological, economical and logistical benefits. It should be considered as an alternative graft option and has been shown to be useful in low resource environments. However, more robust research on the harms and benefits of FSG use is required.

KEY WORDS

Burns

Fish skin graft

Skin graft

Traumatic wounds

Wound healing

VENNESSA C. LEE BN, RN Tissue Viability Nurse, HCA UK

Twice daily use of emollient moisturiser to prevent skin tears among frail older adults in a mental health setting: a narrative review

Skin tears are a significant problem for frail older patients, especially in a mental health setting. Furthermore, they go largely unreported. Frail older adults are vulnerable to dry, thin and fragile skin, which may lead to skin tears. Skin tears can cause unnecessary pain, discomfort and anxiety, as well as stress to patients, carers, and their families. They can also lead to prolonged hospitalisation. In a mental health setting, skin tears are often associated with friction, shear and skin trauma due to self-harm, aggression, psychotropic medications, poor nutrition, depression, a poor lifestyle and a lack of motivation. This paper reviews evidence related to the use of moisturisation as a preventive measure to reduce skin tears among frail older adults in mental health settings. It is evident that moisturising twice daily helps to prevent the incidence of skin tears in frail older adults. However, there is limited research for skin tears in the area of mental health.

KEY WORDS

Emollients

Frail older adult

Mental health

Prevention

Skin tears

Wounds

AYODELE AYENI

Tissue Viability Nurse Specialist, Hertfordshire Partnership University NHS Foundation Trust

Treatment-resistant pyoderma gangrenosum managed with maggot debridement therapy and hyperbaric oxygen therapy: a case study

ABSTRACT: Here we discuss the case of a patient with treatment-resistant pyoderma gangrenosum. We explore the difficulties in managing this condition and reveal the approaches tested in order to bring about clinical improvements.

KEY WORDS

Hyperbaric oxygen therapy

Maggot debridement therapy

Novel treatment

Pyoderma gangrenosum

Wound care

DANIEL LYONS

MB, BCh, BAO, MRCPI, Beaumont Hospital, Beaumont, Dublin 9, Ireland

SARAH FLEMING MB, BCh, BAO, MRCPI, Beaumont Hospital, Beaumont, Dublin 9, Ireland

MARIE DENHAM BSc, Beaumont Hospital, Beaumont, Dublin 9, Ireland

KAREN EUSTACE MB, BCh, BAO, MRCPI, Beaumont Hospital, Beaumont, Dublin 9, Ireland