Wound Healing Southern Africa - latest Issue
Volume 9, Issue 1, 2016
Author Nick KairinosSource: Wound Healing Southern Africa 9 (2016)More Less
In this issue of WHSA, we unfortunately say goodbye to a leader, Professor Alan D Widgerow, who has made this journal what it is today. Under his guidance as Editor-in-Chief, Prof Widgerow nurtured this journal from infancy to a successful biannual journal - the mouthpiece of WHASA. Prof Widgerow utilised his experience and reputation as a highly respected academic and an expert in wound care to muster support from fellow experts to join him on the Editorial Board. This would allow for peer-reviewing, thereby adding credibility to the journal. Despite the journal not yet being accredited by the Department of Higher Education and Training (DHET), Prof Widgerow and his board managed to attract papers from respected authors.
Source: Wound Healing Southern Africa 9, pp 9 –15 (2016)More Less
Objective: To provide an overview of moisture management and its importance in wound care. The authors evaluate the impact of moisture management for optimal wound care and assess current wound management strategies relating to antisepsis and moist wound healing utilizing the wound bed preparation paradigm 2015 update. The discussion distinguishes the form and function of wound care dressing classes available for optimal moisture management.
Conclusion: Moisture management for chronic wounds is best achieved with modern moist interactive dressings if the wound has the ability to heal.
Source: Wound Healing Southern Africa 9, pp 16 –18 (2016)More Less
Wound infection is one of the main areas of concern in the management of the wound environment. Infection complicates treatment and impedes the healing process by damaging tissue, reducing wound tensile strength and inducing an undesirable inflammatory response. More recently, wound dressings (Cutimed Sorbact - BSN medical) have been introduced into clinical practice that reduces bacteria by adsorbing bacteria on the dressing surface through a hydrophobic effect.
Source: Wound Healing Southern Africa 9, pp 19 –24 (2016)More Less
Foot ulceration is the most common complication associated with those living with diabetes. Total contact casting (TCC) is regarded as the gold standard offloading method in aiding rapid healing of neuropathic plantar foot ulcers, and numerous studies and papers indicate its effectiveness. Several TCC methods are used worldwide, the most well-known being the application of TCC with plaster bandage, as described by Levin and O' Neal.However, TCC is still under-used in South Africa, and other offloading devices, such as felt padding of shoe inserts, are primarily used. The reasons for this have been discussed by the authors and healthcare professionals working in this area and, anecdotally, it appears that the most common reason for not using TCC seems to be 'fear of failure'; health professionals are uncertain how to apply TCC and are worried that it will cause more harm than good. It is, therefore, clear that guidance, education and skills training are needed to change this perception in South Africa. Several studies have shown that TCC in skilled hands is safe for the patient. Howard described the use of the Scotchcast? (3M), which has been widely adopted in South Africa. The purpose of this article is to demonstrate why and how the authors, working from two independent outpatient centres that treat patients with diabetic foot ulcers in South Africa, introduced a new TCC system, to meet the needs of the South African patient group.
Randomized controlled trial of three burns dressings for partial thickness burns in children : wound careSource: Wound Healing Southern Africa 9, pp 25 –34 (2016)More Less
Background: This study compared the effects of three silver dressing combinations on small to medium size acute partial thickness burns in children, focusing on re-epithelialization time, pain and distress during dressing changes.
Method: Children (0-15 years) with clean, ≤10% total body surface area (TBSA) partial thickness burns who met the inclusion criteria were included in the study. Children received either (1) Acticoat; (2) Acticoat with Mepitel; or (3) Mepilex Ag dressings. Measures of burn reepithelialization, pain, and distress were recorded at dressing changes every 3-5 days until full re-epithelialization occurred.
Results: One hundred and three children were recruited with 96 children included for analysis. No infections were detected for the course of the study. When adjusted for burn depth, Acticoat significantly increased the expected days to full re-epithelialization by 40% (IRR = 1.40; 95% CI: 1.14-1.73, p < 0.01) and Acticoat with Mepitel significantly increased the expected days to full re-epithelialization by 33% (IRR = 1.33; 95% CI: 1.08-1.63, p - 0.01) when compared to Mepilex Ag. Expected FLACC scores in the Mepilex Ag group were 32% lower at dressing removal (p = 0.01) and 37% lower at new dressing application (p = 0.04); and scores in the Acticoat with Mepitel group were 23% lower at dressing removal (p = 0.04) and 40% lower at new dressing application (p < 0.01), in comparison to the Acticoat group.Expected Visual Analog Scale-Pain (VAS-P) scores were 25% lower in the Mepilex Ag group at dressing removal (p = 0.04) and 34% lower in the Acticoat with Mepitel group (p = 0.02) at new dressing application in comparison to the Acticoat group. There was no significant difference between the Mepilex Ag and the Acticoat with Mepitel groups at all timepoints and with any pain measure.
Conclusion: Mepilex Ag is an effective silver dressing, in terms of accelerated wound epithelialization time (compared to Acticoat and Acticoat with Mepitel) and decreased pain during dressing changes (compared to Acticoat), for clean, <10% TBSA partial thickness burns in children.
Author Susan ThiartSource: Wound Healing Southern Africa 9, pp 35 –40 (2016)More Less
Salvaging length for below-knee-level amputations after burn injury using muscle flaps, negative pressure wound therapy with instillation, and allograft skin : case studySource: Wound Healing Southern Africa 9, pp 41 –44 (2016)More Less
We describe a case of severe flame burns to the bilateral lower extremities following a motor vehicle accident, which required bilateral split gastrocnemius and soleus flaps to obtain coverage of the below-knee-amputation stumps. Knowledge of the blood supply and location of the pedicles of these muscles is critical to their successful rotation in this context. The importance of allografts and negative pressure wound therapy prior to auto grafting is also emphasised. Limited access to allografts remains a considerable barrier for the South African reconstructive surgeon when trying to obtain successful wound coverage in burns and complex wounds.
Performing better under pressure : a case study on the use of topical negative pressure in conjunction with a three-layer compression system for the treatment of a hard-to-heal lower leg ulcer : case studyAuthor F.A. BruwerSource: Wound Healing Southern Africa 9, pp 45 –47 (2016)More Less
Despite medical advances, chronic venous leg ulcers are still a very common and costly problem worldwide. Africa, as a continent, also faces an increase in the incidence of chronic diseases, like diabetes mellitus. The burden of venous lower leg ulcers is expected to rise with an ageing population and the growing epidemic of diabetes mellitus and obesity. This, coupled with chronic venous insufficiency, reduces quality of life and increases healthcare costs as these ulcers may take a very long time to heal. Little data are available on the prevalence of or treatment regimens for patients with venous lower leg ulcers in South Africa. The aim of this case study was to report on the effectiveness of combining the current gold standard for venous lower leg ulcer treatment (compression therapy) with topical negative pressure (TNP) therapy to treat a large surface area lower leg ulcer that was not responding to treatment. This combination treatment not only improved the outcome for the specific patient, but demonstrated that topical treatment alone is insufficient. In addition, associated exacerbating factors must be addressed when managing lower leg ulcers.
Author Marie BackebergSource: Wound Healing Southern Africa 9, pp 48 –49 (2016)More Less
In wound care, the management of leg ulcers requires that the clinician must always consider a venous, arterial or mixed aetiology. Most wound care practitioners are also familiar with the ever present challenge of patients who need to wear compression, but are non-adherent. A common belief in the community and even among clinicians is that patients with leg ulcers need to wear "tight stockings" for optimal healing of wounds, without taking the vascular status into consideration.
Source: Wound Healing Southern Africa 9, pp 52 –53 (2016)More Less
Diabetes is the major cause of lower limb amputations in the world. Africa has the highest percentage of undiagnosed diabetes worldwide. Persons with diabetes in Africa also have the lowest chance of high risk diabetic foot screening. Undetected diabetic foot complications, including preventable loss of limbs and lives,2 are due to the lack of gold standard care. We, the combined voices of Wound Pedia, International Interprofessional Wound Care Course, World Council of Enterostomal Therapists, the Pan-African Diabetic Foot Study Group, Santé Diabète, T1International,3 Wound Healing Association of Southern Africa, and the International Interprofessional Wound Care Group gathered together in Cape Town, South Africa, to call for the implementation of evidence informed interprofessional diabetic foot care.
Source: Wound Healing Southern Africa 9, pp 54 –55 (2016)More Less
People with diabetes are dying in Africa because they cannot afford or access insulin. This is despite nearly 100 years having passed since the discovery of insulin by University of Toronto researchers, who all wished for universal access. Most Africans also do not have the medical supplies, education and monitoring needed to use this life saving medication. One in two people who need insulin cannot afford it. Over the next decade, many of the over 22 million Africans living with diabetes today will die predictable and avoidable deaths without insulin treatment.
Source: Wound Healing Southern Africa 9, pp 56 –57 (2016)More Less
The WCET? recently held its very successful 21th Congress in Cape Town, South Africa. WCET? nursing practice involves the prevention and treatment of skin and wound problems. Advocating for care models that can enhance the treatment of wounds or prevent them entirely is therefore an important part of the work of WCET?.
Source: Wound Healing Southern Africa 9, pp 58 –59 (2016)More Less
Chemical burns to the perineum from podophyllin use. We recently managed a 37-year-old man who had made use of podophyllin, prescribed by his general practitioner, to eradicate perianal condylomata. After two applications and removal after the appropriate duration, the patient became frustrated with its apparent inefficacy, and applied a solution by spray over his scrotum and perineum. He presented to the emergency department three days after application, and was referred to our service after a period of observation by the internal medicine service. The patient was clinically well, but in significant pain. A thorough examination was only possible under sedation, during which the remaining adherent solution was removed, and the areas involved assessed and covered with a dressing of Jelonet? and Polyderm?. The extent of the scrotal and perianal cutaneous injuries is demonstrated in Figures 1 and 2. The clinical examination and blood work were otherwise unremarkable.