Enzymatic versus autolytic debridement of chronic leg ulcers: a prospective randomised trial.
ABSTRACT A randomised clinical trial (n = 42) compared the effectiveness of two approaches to debriding chronic leg ulcers: TenderWet 24, which is designed to support the autolytic degradation process, and Iruxol N (Santyl), an enzymatic treatment claimed to enhance the degradation process.
Patients were randomly assigned to one of the two treatment groups for three weeks. Wounds were evaluated weekly for the amount of eschar/slough, the area of healthy granulation and the re-epithelialised area.
During days 1-14 slough within the groups was reduced by almost 19% for TenderWet 24 and by 9% for Iruxol N, followed by an increase of 26% and 10% respectively in granulation tissue. These effects were less accentuated during days 7-21. There was a further 11% improvement in tissue debridement for the TenderWet 24 group and a relapse (+9.1%) in the Iruxol N group.
Although TenderWet 24 appeared to be more efficient in a few cases, the general efficacy of the two products appeared to be almost the same as no statistically significant superiority of either product was found.
SourceAvailable from: Marin Marinović
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ABSTRACT: Prolonged life expectancy increases the proportion of elderly population. The incidence of injury increases with older age. A variety of comorbidities (circulation disorders, diabetes mellitus, metabolic imbalances, etc.) and reduced biological tissue regeneration potential that accompanies older age, lead to a higher prevalence of chronic wounds. This poses a significant health, social and economic burden upon the society. Injuries in the elderly demand significant involvement of medical and non-medical staff in the prehospital and hospital treatment of the injured, with high material consumption and reduced quality of life in these patients, their families and caregivers. Debridement is a crucial medical procedure in the treatment of acute and chronic wounds. The aim of debridement is removal of all residues in wound bed and environment. Debridement can be conducted several times when there is proper indication. There are several ways of debridement procedure, each having advantages and disadvantages. The method of debridement is chosen by the physician or other medical professional. It is based on wound characteristics and the physician's expertise and capabilities. In the same type of wound, various types of debridement can be combined, all with the aim of faster and better wound healing.
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ABSTRACT: Transient areolar ischemia occurs as a consequence of all breast lift/reduction procedures. Most commonly, it results in no complications or cosmetic consequences. Prolonged or more moderate ischemia results in cutaneous edema and epidermolysis in approximately 5–11% of patients. Complete full-thickness areolar necrosis has been reported to occur in approximately 0.5–7.3% of all cases of cosmetic, oncologic, or reconstructive breast surgery. Despite this unavoidable fact, there does not appear to be any literature focused on the diagnosis and management of this well-documented complication. We present this paper as a review of the current literature and as a way to establish a standard of management of areolar ischemia and necrosis. T ransient areolar ischemia occurs as a consequence of all breast lift/reduction procedures. Most com-monly, it results in no complications or cosmetic consequences. Prolonged or more moderate ischemia results in cutaneous edema and epidermolysis in approximately 5–11% of patients. 1–3 Complete full-thickness areolar necrosis has been reported to occur in approximately 0.5–7.3% of all patients of cosmetic, oncologic, or reconstructive breast surgery. 4–7 Normal anatomic variation, venous congestion, arterial insuf-Þ ciency, surgical misadventure, pedicle kinking, suture obstruction, edema, simultaneous implant prosthesis placement, hematoma, thrombosis, and infection have been reported as causative. 8 Factors associated with increased risk of areolar ischemia are listed in Table 1. The literature is replete with publications focused on anatomic study to improve predictability of the venous and arterial vasculature of the nipple areolar complex (NAC). 9–14 Others have attempted to identify risk factors and develop risk stratiÞ cation of patients undergoing breast surgery in order to assist in aware-ness for patients and surgeons of the inherent risks of surgery. The undeniable fact remains that up to 7.3% of all patients undergoing breast lift or reduction result in ischemia and possible complete necrosis. 4–7 Despite this unavoidable fact, there does not appear to be any literature focused on the diagnosis and management of this well-documented complication. We present this paper as a review of the current literature and to estab-lish a standard of management of areolar ischemia and necrosis.06/2012; 29(2). DOI:10.5992/AJCS-D-11-00062.1
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ABSTRACT: Guidelines based on best available evidence to support pressure ulcer (PU) or venous ulcer (VU) management decisions can improve outcomes. Historically, such guidelines were consensus-based and differed in content and development methods used. Since 2002, the Association for the Advancement of Wound Care (AAWC) Guideline Task Force has used a systematic approach for developing "guidelines of guidelines" that unify and blend recommendations from relevant published guidelines while meeting Institute of Medicine and Agency for Healthcare Research and Quality standards. In addition to establishing the literature-based strength of each recommendation, guideline clinical relevance is examined using standard content validation procedures. All final recommendations included are clinically relevant and/or supported by the highest level of available evidence, cited with every recommendation. In addition, guideline implementation resources are provided. The most recent AAWC VU and PU guidelines and ongoing efforts for improving their clinical relevance are presented. The guideline development process must be transparent and guidelines must be updated regularly to maintain their relevance. In addition, end-user results and research studies to examine their construct and predictive validity are needed.Ostomy/wound management 11/2014; 60(11):24-66. · 1.23 Impact Factor