Wound Healing Southern Africa - Volume 4, Issue 1, 2011
Volume 4, Issue 1, 2011
Author Alan WidgerowSource: Wound Healing Southern Africa 4 (2011)More Less
We're not quite there yet, but we are well on our way to being able to objectively assess wound bed status in terms of inflammation and healing profile. Not only does this allow us to intelligently engage in the process, but our therapeutic interventions will soon be judged, not only on long-term healing outcome, but by intermittent measurement of changes in inflammatory and cytokine profiles.
The practice and science of wound healing : wound bed preparation utilising the guidelines : wound bed preparationAuthor Liezl NaudeSource: Wound Healing Southern Africa 4, pp 4 –10 (2011)More Less
Evidence-based woundcare knowledge comprises both the knowledge and skills gained from clinical experience, and the attitudes and values that individuals bring to the practice. This article focuses on the practical implementation of the Wound Bed Preparation Guideline that was launched at the Wounds International Conference in February 2011, Cape Town. This guideline is supported and endorsed by the Wound Healing Association of Southern Africa (WHASA), UBUNTU Wound Healing, the World Alliance for Wound and Lymphedema Care (WAWLC), Wounds International, and the World Union of Wound Healing Societies (WUWHS).
Source: Wound Healing Southern Africa 4, pp 12 –15 (2011)More Less
Wound fluid constituents are often used as a means to mirror events occurring at a molecular level within the wound. This is especially so in chronic wounds, where excess destruction of the extracellular matrix is brought about by exuberant activity of potent clearing agents, predominantly in the form of matrix metalloproteinases (MMPs). These MMPs are found to exist in significant amounts in the chronic wound fluid. It has become apparent that these enzymes not only reflect the destructive milieu within the wound, but may in fact contribute to this destruction by nature of their corrosive effects on the wound bed and peri-wound skin. A new approach to influencing wound healing may logically involve neutralising these corrosive enzymes within the wound fluid, and initiating a more balanced MMP:growth factor ratio. It is expected that this would trigger healing. This paper examines the logic of this approach, and suggests possible ways in which current dressings may already be influencing wound healing due their effect on chronic wound fluid.
Stevens-Johnson syndrome and toxic epidermal necrolysis : topical treatment influencing systemic response : treatment modalitiesSource: Wound Healing Southern Africa 4, pp 17 –24 (2011)More Less
Toxic epidermal necrolysis (TEN) and Steven-Johnson syndrome (SJS) are rare, but potentially life-threatening diseases, which relate to a variety of medications, and which are characterised by widespread epidermal necrosis. Although sepsis is currently accepted as the main cause of mortality, much of the morbidity and subsequent threat to life is orchestrated by an exaggerated inflammatory response with major outpouring of cytokines and destructive matrix metalloproteinases (MMPs). These mediators and proteinases cause intense destruction of the extracellular matrix, major fluid shifts, and a systemic inflammatory response (SIRS) that has life-threatening consequences. Modern therapeutic interventions, aside from resuscitative efforts, have sought to control not only the potential sepsis, but also the marked inflammatory response in relation to this pathology. Nanocrystalline silver (NCS) is one such agent. It has exceptional antimicrobial efficacy, but is also effective in lowering MMP levels, a critical part of the disease process. Twelve cases of confirmed TEN, treated with NCS, were analysed with a view to assessing efficacy and setting logical guidelines for this devastating condition. Eleven out of the 12 cases were categorised in the TEN diagnostic group, with total body-surface area involvement ranging from 22-100% (mean 64%). Two patients in the series died (16.6%), but both had a severe co-morbid disease background. Topical application of NCS (Acticoat®, Smith and Nephew Hull, UK) dressings, as part of a comprehensive dressing protocol, proved successful in the management of this devastating disease. Guidelines for the management of TEN are suggested.
The role of advanced glycation end products in the hyperinflammatory response of diabetic wounds : general reviewSource: Wound Healing Southern Africa 4, pp 25 –28 (2011)More Less
Chronic wounds are a frequent complication in diabetic patients and contribute significantly to morbidity and mortality. In the hyperglycaemic state, advanced glycation end products (AGEs) form, affecting collagen cross-linking, cytokine, nitric oxide and growth factor production and molecular signalling pathways. AGE receptors are upregulated and as it activates NF-kappaB, a host of inflammatory cytokines are expressed, exacerbating the self-sustaining inflammatory response seen in diabetic wounds. Therapeutic strategies include inhibiting the formation of AGEs, either directly or by inhibiting the formation of intermediates, and blocking the AGE receptor. A more complete understanding of the biology of the diabetic wound healing process is imperative in the development of successful treatment of diabetic wounds.
The open abdomen - part 2 : management of the open abdomen using temporary abdominal closure : general reviewSource: Wound Healing Southern Africa 4, pp 29 –35 (2011)More Less
Management of the open abdomen is a complex undertaking, as it not only involves difficult wound healing but also the prevention of many serious local and systemic complications. In this article the different types of temporary wound closure methods and their pros and cons are discussed. It appears from our experience that specific negative-pressure dressings produce the best outcomes with regard to morbidity and mortality, as they are adapted to address the particular needs of different grades of open abdomen.
Author Gerda Van RensburgSource: Wound Healing Southern Africa 4, pp 38 –43 (2011)More Less
The risk of developing a foot ulcer and the potential to proceed to limb amputation is a feared complication amongst people with diabetes. It has been shown that foot ulceration precedes amputation in up to 85% of lower limb amputations. For healthcare providers involved in the treatment of foot ulceration, it is often a frustrating experience, as reulceration is common after great effort and cost to achieve a healed status. This article looks at the biomechanical factors involved in the causal pathway, the healing process and the prevention of ulceration and reulceration of a foot ulcer in a person with diabetes.