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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
ABSTRACT: His Majesty’s Prison and Probation Service uses age 50 to describe ‘old age’ in prisons, with the average age of people dying in prison being 56 compared with 81 in the general population. Patients in custody are a uniquely vulnerable population with a disproportionately high burden of disease and an increased mortality rate compared with the wider UK population. Prison nurses manage a diverse and complex range of wound presentations, from acute trauma, self-harm wounds, complex burns, and chronic disease, requiring a range of wound care interventions, with one of the most challenging wound types being leg ulceration. A wound care strategy was developed to provide overarching support, to improve access to training, while developing the knowledge and skills to ensure safe practice. Furthermore we wanted to develop a cohort of passionate nurses with a specific interest in tissue viability who would maintain the wounds agenda, transform wound management, and more importantly, enhance timely wound healing for this vulnerable patient population.
KEY WORDS
Assessment
Education
Leg ulcer management
Prisons
Secure settings
UrgoKTwo
SARAH LAVER, RGN, Professional Nurse Advocate, Regional Primary Care Lead: Thames Valley and South Central, Practice Plus Healthcare Group
Chirag Bakhai GP, Luton, and Primary Care Advisor to the NHS Diabetes Programme
Citation:
Bakhai C (2023) Overview of the NHS Type 2 Diabetes Path to Remission Programme. Diabetes & Primary Care 25: 105–6
Z-C. Hu1, D. Chen2, D. Guo3, Y.-Y. Liang1, J. Zhang1, J.-Y. Zhu1 and B. Tang1
Departments of 1Burn Surgery and 2Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, and 3Department of Plastic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China Correspondence to: Dr B. Tang, Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou 510080, China (e-mail: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。)
Background: Treatment of chronic wounds using traditional surgical procedures is challenging because of the low graft take rates. This study investigated the combination approach of split-thickness autografts with harvested skin cell suspension for chronic wound treatment.
Methods: This randomized clinical trial enrolled patients with chronic wounds between March 2012 and December 2013. Patients who were assigned randomly to the active treatment received a split-thickness autograft combined with harvested skin cell suspension. Control patients received the split-thickness autograft alone. The primary outcome was the rate of complete wound closure by postoperative day 28. Analysis was by intention to treat. Patients who achieved wound closure were followed up for a minimum of 6 months to evaluate the quality of healing.
Results: A total of 88 patients were included, 44 in each group. More patients achieved complete wound closure in the skin cell group than in the control group (41 versus 34 patients; P = 0⋅035). Complete wound closure was observed at a median of 14 (95 per cent c.i. 12⋅0 to 16⋅0) days in the skin cell group and 20 (15⋅7 to 24⋅3) days in the control group (P = 0⋅001). The skin cell group had significantly fewer complications (4 versus 11 patients; P = 0⋅047). The autografted sites displayed better physical attributes and a reduced tendency for wound recurrence in the skin cell group.
Conclusion: Complementary split-thickness autologous skin grafting with autologous skin cells harvested using MYSEED细胞分选仪® technology improved the healing rate of chronic wounds.
Registration number: UMIN000011966 (http://www.umin.ac.jp/ctr).
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Paper accepted 29 September 2014
Published online in Wiley Online Library (www.bjs.co.uk). DOI: 10.1002/bjs.9688
