Wound Healing Southern Africa - Volume 7, Issue 2, 2014
Volume 7, Issue 2, 2014
Author Gerda Van RensburgSource: Wound Healing Southern Africa 7 (2014)More Less
This issue of Wound Healing Southern Africa focuses on pressure ulcers, a worldwide health concern due to both the associated staggering financial burden and resultant human suffering. The focus is now on the prevention rather than treatment of pressure ulcers as some countries have introduced reimbursement regulations for hospital-acquired and avoidable conditions not present on admission to hospital and which are viewed as medical errors. Most pressure ulcers are avoidable and a core indicator of the quality of care delivered in a healthcare system or institution. Many institutions and organisations have introduced and implemented strategies to reduce the incidence rates. The ABCDE of Pressure Ulcer Incidence Reduction Initiatives was outlined at the 12th National Pressure Ulcer Advisory Panel's Biennial Conference 2011. Therefore, incidence and prevalence rates are essential measures in evaluating the effectiveness of any intervention to prevent pressure ulcers. The basic principle of quality measurement needs to be applied: "If you can't measure it, you can't prove it".
Author K. GerberSource: Wound Healing Southern Africa 7, pp 37 –38 (2014)More Less
Pressure ulcers or bedsores, as referred to previously, have been a burden of care for many years. Healthcare practitioners, care providers, and many other role players in the care circle of the patient have voiced concerns about the prevalence of pressure ulcers, and the assumed lack of guidelines on how to manage them, as well as how to identify patients at risk, in order to prevent their development. This brief highlights some aspects relating to good clinical practice, proactive pressure prevention and the management or care of patients and pressure ulcers.
Author G.B. LandauSource: Wound Healing Southern Africa 7, pp 40 –44 (2014)More Less
Pressure ulcers, also known as pressure sores, bedsores or decubitus ulcers, are defined by the National Pressure Ulcer Advisory Panel as an area of localised injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure or pressure in combination with shear. Old age, uncontrolled diabetes, sepsis, neurological and vascular disease, spinal cord damage, malnutrition and trauma are also recognised risk factors for pressure ulcer development. Malnutrition and pressure ulcers are major contributors to decreased function, quality of life, increased morbidity and mortality, increased frequency and length of hospital stay and higher healthcare costs. The role of a multidisciplinary care team cannot be underestimated owing to the complex underlying pathology of pressure ulcers. A registered dietitian is part of the team. This article will explore the roles of the registered dietitian in terms of the identification of at-risk patients and the implementation of a comprehensive nutritional plan.
Source: Wound Healing Southern Africa 7, pp 45 –52 (2014)More Less
Pressure ulcers are tissue damage, mainly over a bony prominence, occurring in critically ill, paraplegic, bedbound and elderly patients. They are classified from stage 1-4, and the most common sites are around the pelvic area (sacral, trochanteric and ischial). Stages 1 and 2 usually heal with non-surgical, conservative management, while stages 3 and 4 require a surgical approach. Preoperative, intraoperative and postoperative measures are paramount for the successful operative repair of pressure ulcers, together with proper patient selection and adequate support from the patient's circle of care. Surgical choice is based on principles, surgeon experience and preference, subject to individual and patient choice. Reconstructive options are based on the complexity of the repair, the type of tissue used to close the ulcer, and specific flap design chosen by the trained reconstructive surgeon. The procedures, in ascending level of complexity, are direct (primary) closure; skin grafts; and local, fasciocutaneous, muscular, myocutaneous, perforator and free flaps. A high recurrence rate, associated complications and costs remain a challenge with regard to the surgical management of these chronic wounds, and this remains common worldwide. Prevalence studies are lacking in South Africa, and preclude estimates of associated costs relating to the clinical and surgical treatment of pressure ulcers in the country. Prevention is still the best management strategy to avoid litigation and the elevated costs of pressure ulcer management.
A case study demonstrating the use of appropriate dressings to promote patient wellbeing : case studyAuthor Elizabeth SparkesSource: Wound Healing Southern Africa 7, pp 53 –54 (2014)More Less
Author L. NaudeSource: Wound Healing Southern Africa 7, pp 56 –60 (2014)More Less
Foot ulcerations are the most common complications associated with the patient living with diabetes worldwide, and South Africa is no different. Several total contact casing methods worldwide are available. The description of the application of a total contact cast (TCC) with plaster bandage (Gypsona®), as described in Levin and O'Neal's The Diabetic Foot is probably the most well known. Undisputedly, total contact casing is regarded as the gold standard offloading method used for the rapid healing of neuropathic plantar foot ulcers. Numerous studies and papers indicates its effectiveness. Unfortunately, total contact casing is still underused in the South African environment and other offloading devices, such as felt padding in shoe inserts, are used primarily. Several reasons for this have been discussed with peers and other healthcare professionals. The most common seems to be "the fear of failure". Health professionals are uncertain as to how to apply the TCC, and are worried that they will cause more harm than good. From this, it is clear that guidance and education are needed, including skills training, in order to change this perception. It has been shown in several studies that total contact casing is safe for the patient in skilled hands.
Author Suzi DaveySource: Wound Healing Southern Africa 7, pp 61 –65 (2014)More Less
Lymphoedema is a progressive, chronic oedema condition that can have significant effects on psychosocial health, physical health and quality of life issues for patients. Proper diagnosis, early detection and appropriate treatment can effectively slow the progression of Lymphoedema. Wound care specialists should be aware of this condition and address not just the wound but the proximal and distal oedematous areas contributing to delayed wound healing. Even if diagnosed properly, health care practitioners and patients are often unaware that specialised treatment is available to treat Lymphoedema in South Africa and may not know where to seek help. This is one reason why the Lymphoedema Association of South Africa (LAOSA) was formed in 2012 by a group of Lymphoedema Specialists, each with over 135 hours of International Certified Training.
Source: Wound Healing Southern Africa 7, pp 66 –69 (2014)More Less
Adipose-derived stem cells (ADSCs) have been proposed as a treatment modality in burn wound management. While the therapeutic use of ADSCs increases, their mechanisms of action pertaining to wound healing are still poorly understood. Although fat tissue from lipoaspirate may induce wound healing under certain circumstances, in other situations it is possible that ADSCs may cause or exacerbate hypertrophic scarring (HTS). This potentially deleterious effect is considered to be due to excessive angiogenesis and tissue granulation propagated by the presence of the ADSCs. The overstimulation of vascular endothelial growth factor that may occur in burns of a certain depth and state of maturation is likely to cause this hypergranulation. ADSCs, or the stromal vascular fraction (SVF) cells, have been found to be effective in initiating softening and/or transformation in scar consistency and compliance in already established hypertrophic scars and scar contractures. In contrast, in certain phases of acute burn wound injuries, particularly when fat cones are exposed in deeper injuries, the addition of ADSCs may contribute to HTS. Until the mechanisms of action of lipoaspirate components (SVF or ADSCs) are better understood, physicians should proceed with caution before applying lipoaspirate contents to the surface of burn wounds.
Source: Wound Healing Southern Africa 7 (2014)More Less
It is with deep sadness that we mourn the untimely death of Dr Douw Greeff, director of Medpharm. His enthusiasm for nurturing all of the journals published by Medpharm went far beyond merely attending to administrative and technical functions. His passion for innovation helped each journal to achieve its full potential.