Wound Management Forum - Archive (1999-2000)

Messages

Wound management with FIR Dressing Date: 1999, Sep 21 From: Joey M. Sinchioco, M.D.

Hi to all I'm just wondering if anyone has an expereince using bioceramics far-infrared surgical dressing for wound management. Thank you and have a pleasant day Joey M. Sinchioco, M.D.

HELP NEEDED OPEN WOUND Date: 1999, Nov 06 From: Kris

Today, it is 5 November, 1999. Exactly one month ago, I fell in an open sewer and a rod impailed into my leg and took off a large chunk of my leg to the right of my shin. The wound is now about 1 inch wide and an inch and a half long as well as deep. The doctor started my on hydra therapy which ended this week. I still have difficulty walking and the wound has only closed up 6 millimeters. I have a few questions: First the doctor started me on a wet to dry with saline not packing the wound. Just a cover over the wound. This went on for one week. Second the wound became infected...gross, so the doctor sent me to a surgeon.....the surgeon sent me to hydra therapy, I did not need surgery. The physical therapist had me whirlpool and after the whirlpool, they packed the wound with saline and packing strips for 1 week. Week 2, the therapist started using something called Intrasite which was much better and comfortable for the wound. Then week 3, on the last day of therapy, the therapist started me on something called saf-gel with alginate. That was yesterday. HELP IT BURNS. I called the therapist..she said to go back to a wet to dry if it burns...does this sound right? I do not like the wet to dry because it dries into the wound and pulls and is in a spot that is painful. The only thing that I have liked was the Intrasite gel. I am just confused about how to treat the wound, and I do not think my doctor has much experience with wounds. My other question is when can I stop packing the wound? Or what is the next step in managment after the gels?

wound management Re: HELP NEEDED OPEN WOUND - (Kris) Date: 1999, Nov 09 From: Sue Dunn

This sounds horrendous. Here in the UK, nurses tend to deal with wounds not GP's. We tend to use a moist healing environment, and there should be plenty of stuff you can find on the web to give you information regarding dressings and their methods of working. I'm sure you did find treatment with Intrasite more comfortable than gauze strips, I can't remember the last time I packed a cavity with gauze. Try www.smtl.co.uk for some dressing and wound management information. Good luck, I hope it heals soon

Home wound care Re: wound management - (Sue Dunn) Date: 2000, Feb 17 From: Tricia Kirksey

I am a PTA student currently in a 5 week clinical. As my clinic performs a great deal of wound care, I have been asked to present an inservice. I am looking for any information to provide for a patient to care for a wound at home. Any information would be greatly appreciated.

please tell me how to treat an open wound Re: Home wound care - (Tricia Kirksey) Date: 2003, Sep 01 From: monica

hi, a week ago i cut myself with a knife pretty badly.a chunk of flesh was mising.i obtained medical help,and recieved 4 stitches.the nurse closing the wound said they were out of the proper sutures so she used the next best thing. now 6 days later when the stitches were removed , the wound is still wide open. please tell me how i can treat this myself.i work in a public place and am sure to be infected. your help is greatly appreciated.

bed sore ,burns wounds treatment without graft Re: wound management - (Sue Dunn) Date: Aug 22, 20:17 From: <Anonymous>

It is worth noting that I have reviewed the patients and also the response to the patients by the doctors about the way of treatment was received. The European and American pharamcaucists have no effective medicine for the ultimate treatment of the bed sore and of 2nd and 3rd degrees and superficial wounds whereas the number of injured patients has been increasing day by day and the world has been suffering a disaster. There has been no country to have had a declinning trend in the disease . The prevetion method of the treatment of the wounds has not been found.I advise that the bed sore and burns medicine has been discovered by me and entered into the international market.Some of the patients photos of the burns patients and bed sore ones treated by Kimia ointment without graft can be viewed in my web site www.avicennaherbalmedicine.com there are some new photos of the patients which will be presented to those who are interested. Dr.Mohammad Nejadi e-mail info at avicennaherbalmedicine.com Tel 0098 21 7600912 7511702

wound management Date: 1999, Nov 09 From: Sue Dunn

This sounds horrendous. Here in the UK, nurses tend to deal with wounds not GP's. We tend to use a moist healing environment, and there should be plenty of stuff you can find on the web to give you information regarding dressings and their methods of working. I'm sure you did find treatment with Intrasite more comfortable than gauze strips, I can't remember the last time I packed a cavity with gauze. Try www.smtl.co.uk for some dressing and wound management information. Good luck, I hope it heals soon

Home wound care Re: wound management - (Sue Dunn) Date: 2000, Feb 17 From: Tricia Kirksey

I am a PTA student currently in a 5 week clinical. As my clinic performs a great deal of wound care, I have been asked to present an inservice. I am looking for any information to provide for a patient to care for a wound at home. Any information would be greatly appreciated.

Fill in the blank of wound care Re: wound management - (Sue Dunn) Date: 2001, Feb 01 From: a.c.

This is a must see for any open wound patients, Dr. Xi's formulas have been used in hospitals for last 40 years, over 200,000 patients. Just look at the photos of the progress. Compare to the formula's effective, Western conventional wound care technique is just a baby.. http://www.psp.bc.ca click on Dr. Xi's formula Very truly yours, A. C.

The use of a betadine wick in abdominal wounds post surgery Date: 2000, Apr 13 From: <eunmaj at gofree.indigo.ie>

Can anyone inform me as to the objective of placing a betadine wick in the abdominal wound of a patient post abdominal/pelvic surgery. I have seen this regime in practice, with the wick being removed, the wound irrigated, and a new wick placed in situ. This regime is continued until there is evidence of granulation.I forgot to mention that the patient also had tension sutures insitu and skin sutures. Is this practice evidence based?

wound mgmt with wicking Re: The use of a betadine wick in abdominal wounds post surgery - Date: 2000, Sep 10 From: Rae

At this time I have a wound over L4 L5 from a spinal fusion. The day after surgery the P.T. person tried to put on my brace and when he had difficulty, pulled the brace through and the edge of the brace pulled a staple loose. Later this became my wound. It eviscerated and tunnelled because of failure to heal. At this time I have a worm-hole (known as a tunnel in medicalease) in my back about two inches plus. Twice a day dressings are removed, it is irrigated with sterile normal saline, and a wick of nu-gauze is inserted loosely, the purpose of which is to draw out the drainage so that it will not heal on the outside and form an abscess on the inside. In the beginning this is exactly what it did and the abscess would break through periodically and drain and so it was opened up by the doctor and the wicking procedure started. It does seem to be successful because no more abscess is being formed and it is not infected. I am still taking an antibiotic. Healing is taking place very slowly and I do not know if it is granulating yet. I have asked my surgeon what we are going to do after it heals (granulates) and he has said that we have choices depending on the healing and we can create a new raw surface and re-close this new surface in order to get healing. Maybe. Of course, I am unhappy because in my case I would not have this ugly wound and risk of infection if it were not for careless handling by my physical therapist ! In the case of an abdominal wound, perhaps it is the site of a drain and is taking the place of a drain. Let me know how you progress. Your fellow patient.

wound mgmt with wicking Date: 2000, Sep 10 From: Rae

At this time I have a wound over L4 L5 from a spinal fusion. The day after surgery the P.T. person tried to put on my brace and when he had difficulty, pulled the brace through and the edge of the brace pulled a staple loose. Later this became my wound. It eviscerated and tunnelled because of failure to heal. At this time I have a worm-hole (known as a tunnel in medicalease) in my back about two inches plus. Twice a day dressings are removed, it is irrigated with sterile normal saline, and a wick of nu-gauze is inserted loosely, the purpose of which is to draw out the drainage so that it will not heal on the outside and form an abscess on the inside. In the beginning this is exactly what it did and the abscess would break through periodically and drain and so it was opened up by the doctor and the wicking procedure started. It does seem to be successful because no more abscess is being formed and it is not infected. I am still taking an antibiotic. Healing is taking place very slowly and I do not know if it is granulating yet. I have asked my surgeon what we are going to do after it heals (granulates) and he has said that we have choices depending on the healing and we can create a new raw surface and re-close this new surface in order to get healing. Maybe. Of course, I am unhappy because in my case I would not have this ugly wound and risk of infection if it were not for careless handling by my physical therapist ! In the case of an abdominal wound, perhaps it is the site of a drain and is taking the place of a drain. Let me know how you progress. Your fellow patient.

Wound management following a spinal rod insertion Date: 2000, Aug 21 From: Irene Cooke

Has anyone experience of nursing a patient who has had a thoracic spinal rod insertion for spinal metastatic disease ( a course of XRT followed the surgery)which subsequently develops into a full thickness wound some 2 years later. The rod appeared to protrude from the patients' skin and over a period of almost a week, the rod became visible due to the degeneration of the surrounding skin and underlying tissures. It was difficult to determine the causation of the prosthetic protusion and attempts were made to reduce the external tissue interface pressures ,however the wound continued to deteriorate. Any correspondance in relation to this specific issue is welcomed. Irene Cooke

Redness around wounds after larval therapy. Date: 1999, Sep 20 From: John Byrne/Tamara Hawk

Wondering if anyone has reported and/or seen a chemical like burn around the periwound region where the drainage has sat for a day or two. The tissue is a bright, intense red in color and has the appearance of a chemical burn. The doctors that I am working with feel it is due to the breakdown of certain bacteria. I have been doing maggot therapy for 2 years now and have never experienced this before. It has only been the last two patients that have had this difficulty.

Redness around wounds after larval therapy. Re: Redness around wounds after larval therapy. - (John Byrne/Tamara Hawk) Date: 1999, Sep 20 From: Dr Steve Thomas

Hi We are aware of this effect. It is caused by the maggot enzymes spreading onto the skin around the wound. These attack the keratinized epidermis (which is effectively dead tissue) leading to the redness you have observed. It generally only happens when the maggots are feeding well and producing large quantities of secretions. To prevent this problem occurring we normally recommend that the skin surrounding the wound is protected with a hydrocolloid dressing or zinc paste.

effects of isopropyl alcohol on neonatal skin Re: Redness around wounds after larval therapy. - (John Byrne/Tamara Hawk) Date: 1999, Sep 20 From: valerie @irvingv.freeserve.co.uk

In order to raise the awareness of medical and nursing staff on the importance of evaluating all cleansing products used on the very preterm infants I am trying to find information on the effects of isopropyl alcohol on the skin of this vulnerable population. can anyone give any research based information on this matter?

wound/ulcer volume measurments Re: Redness around wounds after larval therapy. - (John Byrne/Tamara Hawk) Date: 2000, Jan 05 From: Wamid

What do you use to measure the volume/area of the wound? and can you tell the type of the ulcer from its volume?

Untitled Re: wound/ulcer volume measurments - (Wamid) Date: 2001, Mar 27 From: <wddesmond at telstra.easymail.com.au>

Most definately cannot define ateiology by wound measurements & the easiest way to calculate volume wound be the old fashioned length x width x depth. Deb D

Redness around wounds after larval therapy. Date: 1999, Sep 20 From: Dr Steve Thomas

Hi We are aware of this effect. It is caused by the maggot enzymes spreading onto the skin around the wound. These attack the keratinized epidermis (which is effectively dead tissue) leading to the redness you have observed. It generally only happens when the maggots are feeding well and producing large quantities of secretions. To prevent this problem occurring we normally recommend that the skin surrounding the wound is protected with a hydrocolloid dressing or zinc paste.

effects of isopropyl alcohol on neonatal skin Date: 1999, Sep 20 From: valerie @irvingv.freeserve.co.uk

In order to raise the awareness of medical and nursing staff on the importance of evaluating all cleansing products used on the very preterm infants I am trying to find information on the effects of isopropyl alcohol on the skin of this vulnerable population. can anyone give any research based information on this matter?

ISOPROPYL ALCOHOL DEADLY Date: 2000, Oct 10 From: <Anonymous>

YOU ASKED FOR INFO RE IPA........SUGGEST YOU READ 'CURE FOR ALL DISEASES' BY DR HULDA CLARK (OR ANY OF HER BOOKS)

Nasal Spray Date: 1999, Sep 20 From: Sandra Tremblay PT, MS, CWS

A dermatologist recently prescribed a nasal spray for a granulating stage III pressure sore, followed by a hydrocolloid dressing. What is the action of the nasal spray?

Nasal spray Re: Nasal Spray - (Sandra Tremblay PT, MS, CWS) Date: 1999, Sep 20 From: Liza G. Ovington, PhD, CWS

This is a new one! I am wondering if the doctor has had experiences with hypergranulation with hydrocolloids and is perhpas using a corticosteroid nasal spray as sort of a "prophylactic" to avoid this effect before placing the hydrocolloid? We would really need to know the exact nasal spray to answer this since there are different types - there are corticosteroid (beclomethasone) sprays, vasoconstrictors (oxymetazoline) and even nasal sprays that are just plain old saline - See if you can find out more and let us know Curiously yours, Liza

Nasal spray Date: 1999, Sep 20 From: Liza G. Ovington, PhD, CWS

This is a new one! I am wondering if the doctor has had experiences with hypergranulation with hydrocolloids and is perhpas using a corticosteroid nasal spray as sort of a "prophylactic" to avoid this effect before placing the hydrocolloid? We would really need to know the exact nasal spray to answer this since there are different types - there are corticosteroid (beclomethasone) sprays, vasoconstrictors (oxymetazoline) and even nasal sprays that are just plain old saline - See if you can find out more and let us know Curiously yours, Liza

"Warm Up" Active Wound Therapy Date: 1999, Sep 21 From: Brenda Ramstadius

Greetings from down under, Has anyone had any clinical experience with the "Warm Up" active wound therapy device. It is currently being promoted in Australia, but I am very hesitant to trial it. The cost of the device is not readily disclosed by the company (which sets alarm bells ringing) and its use will appear to restrict patient movement (needing to be plugged into a power source) in comparison to moist wound healing products. It just seems a bit too gimmicky for me...what are your thoughts &/or experiences with this device?

Warm-Up Therapy Re: "Warm Up" Active Wound Therapy - (Brenda Ramstadius) Date: 1999, Sep 21 From: Kathy Williamson, BS, BSN, MSM

I have used the Warm-up Therapy on two patients without success on either patient. There are basically two costs - one incurred is the rental fee on the warm-up which includes the small pad which slides into the dressing, and the dressings. In all, the cost for therapy was approximately $2000+ for the patient. Insurance and MCARE and MCAID are hesitant on paying for the therapy. The idea behind the product is to keep the wound bed moist and warm to promote healing. Dressings will not adhere to legs which have become banded due to venous insufficiency, on people who sweat heavily or who are active, and our patients complained about the dressing being uncomfortable. We do not use this therapy in our wound department.

Warm-Up Therapy Date: 1999, Sep 21 From: Kathy Williamson, BS, BSN, MSM

I have used the Warm-up Therapy on two patients without success on either patient. There are basically two costs - one incurred is the rental fee on the warm-up which includes the small pad which slides into the dressing, and the dressings. In all, the cost for therapy was approximately $2000+ for the patient. Insurance and MCARE and MCAID are hesitant on paying for the therapy. The idea behind the product is to keep the wound bed moist and warm to promote healing. Dressings will not adhere to legs which have become banded due to venous insufficiency, on people who sweat heavily or who are active, and our patients complained about the dressing being uncomfortable. We do not use this therapy in our wound department.

Warm Up Therapy Date: 2001, May 28 From: Greg Wain BSc. RGN. RMN. ENB 264 / 870

Yes i have had some very successful outcomes using warm up as an adjunct to vac therapy, while working as CNS Tissue Viability, Royal National Orthopaedic Hospital Stanmore, London. It appears to speed up the process of autolytic debridement by improving blood perfusion to the wound. I noticed the slough in grade 4 pressure ulcers became liquefied in 2 to 3 days. This treatment is useful in preparing spinally injured patients for plastic surgery reconstruction of their deep cavity pressure ulcers. I think more work is needed in looking at myocutaneous flap survival rates following warm up therapy. I suspect that by applying warm up prior to flap surgery, the risk of distal flap necrosis would be diminished. Greg Wain Plastic Surgery Specialist Nurse Chelsea and Westminster Hospital London UK

Re. "Warm Up" Date: 1999, Sep 21 From: olli

I have used the "Warm-up" unit and found it to be expensive and not very effective. The patient was a 65 yr old female with a medial malleuos wound caused by a dehiscence of tarsal tunnel surgery. The wound was going into its 8th mth and we were not making much headway. The first week we assessed a change in the color of the wound which had been very pale with no granular tissue The color of the wound base did improve within the 1st week however after 3 weeks no further improvement was noted and the "Warm-up" was discontinued

Wound Data Bases Date: 1999, Sep 21 From: Rae Johnson

Is anyone using data bases for data collection on wounds partiicularly burn wounds. I'm using Access and I'm interested in descriptors, definitions and body charts.

Untitled Re: Wound Data Bases - (Rae Johnson) Date: 1999, Sep 29 From: Simon Booth

We currently have our own unit database (using access) which audits all patients which come throught he unit (looking at causes,wound depth etc) If you are involved in burns then you should be aware that BIBID (british isles burns interest database) is about to be released if not can send more details

Wound Database Re: Wound Data Bases - (Rae Johnson) Date: 1999, Dec 13 From: R Johnston

You may want to check out the Wound Tech program by Ocean Informatics at www.oceanmedical.com The program allows you to track wounds, healing rates, attach photographs of the patient's wounds directly to their chart and do searches for specific demographic information such as healing rates for certain types of patients. There number is 877-576-4410

databases Re: Wound Data Bases - (Rae Johnson) Date: 2000, Mar 19 From: Ian

We use Access data base in the community. Leg Ulcer database monitor healing rates of over 900 patients.We can determine types of ulcers compression systems used recurrence rates, stocking compliance correlate size of ulcer with healing.Location (Clinic vs Home)age,sex etc.pivot tables utilised to compare data. Provide reports to authority.

Wound Database Date: 1999, Dec 13 From: R Johnston

You may want to check out the Wound Tech program by Ocean Informatics at www.oceanmedical.com The program allows you to track wounds, healing rates, attach photographs of the patient's wounds directly to their chart and do searches for specific demographic information such as healing rates for certain types of patients. There number is 877-576-4410

databases Date: 2000, Mar 19 From: Ian

We use Access data base in the community. Leg Ulcer database monitor healing rates of over 900 patients.We can determine types of ulcers compression systems used recurrence rates, stocking compliance correlate size of ulcer with healing.Location (Clinic vs Home)age,sex etc.pivot tables utilised to compare data. Provide reports to authority.

My introduction Date: 1999, Sep 21 From: Kathy Howson

Hi, I am Kate (a colleague of Brenda's actually). I am a Clinical Product Manager for a health service and have an interest in wound care and would love to share information about wound care products, and get others opinions of products. Thanks for the opportunity

Untitled Date: 1999, Sep 21 From: k.khadalia

any experience with ozone therapy for wounds

Ozone in Wounds Re: Untitled - (k.khadalia) Date: 1999, Sep 21 From: Ted Yeoman

Ozone would appear to be a bad idea, unlike hyperbaric 02, Ozone, O3, is unstable and breaks down to O2 + O (a free oxygen radical). These radicals have a nasty habit of destroying most enzyme systems. If anybody has clinical data to the contrary, I stand corrected

ozone Re: Untitled - (k.khadalia) Date: 2000, Apr 13 From: roberto

We are using ozonized water in cleasing some wound. There is not any observation about toxic effects of ozone on fibroblast or macrophages. On the contrary the antiseptic effect of ozonized water is good (there are some german articles)and ozone is cheap and you can use a lot so you have two activities, antiseptic and cleansing. It is only our experience without any scientific demonstration, I am sorry. Bye Roberto (Florence - Italy)

Ozone in Wounds Date: 1999, Sep 21 From: Ted Yeoman

Ozone would appear to be a bad idea, unlike hyperbaric 02, Ozone, O3, is unstable and breaks down to O2 + O (a free oxygen radical). These radicals have a nasty habit of destroying most enzyme systems. If anybody has clinical data to the contrary, I stand corrected

Quality of Life Instruments for Wound Care Date: 1999, Sep 21 From: <kris.kieswetter at dptlabs.com>

Hello. I am interested in what (if any) instruments are used in assessing the quality of life of wound care patients. I would be particularly interested in knowing if any of these are being used in palliative care settings. Thank you.

Kate - quality of life re wound care Re: Quality of Life Instruments for Wound Care - Date: 1999, Sep 23 From: Kathy Howson

Hi Kris, I can't answer this now but as I have contacts in Palliative Care I will ask about. When I worked in PC it was mainly up to the patient and carer what they preferred and able to manage - particularly if at home. Kate

Kate - quality of life re wound care Date: 1999, Sep 23 From: Kathy Howson

Hi Kris, I can't answer this now but as I have contacts in Palliative Care I will ask about. When I worked in PC it was mainly up to the patient and carer what they preferred and able to manage - particularly if at home. Kate

re: hypergranulation Date: 1999, Sep 21 From: <donnasalata at yahoo.com>

hi all, new to the site and very excited by the concept. i have a patient whose stasis ulcer has become stubbornly hypergranulated and has not responded well to traditional therapies i.e. bactroban, compression wraps. abi's are good. any suggestions? (i know you will) thanks....donna

Untitled Re: re: hypergranulation - Date: 1999, Sep 22 From: olli

I attended a wound conference today and there was discussion regarding hypergranulation. There were 3 suggestions 1. to apply pressure with rolled gauze. 2. apply pressure with the fingertips to the tissue in question 3. use silvernitrate stick to tissue. I have used silver nitrate sticks successfully, have not tried 1 or 2

hypergranulation Re: re: hypergranulation - Date: 1999, Sep 22 From: Luk De Crom

Hello Donna, Have you already changed your local-basic therapy? I made good experiences by using an alginate (i.e. Tegagen 3M) in combination with a transparent film (i.e. Tegaderm 3M). This combination is less "active" as an hydrocolloïd and reduce the prevalence of hypergranulation. Complementary to this, I use compression to rebuild hypergranulated tissues. bye Luk De Crom

Hypergranulation Re: re: hypergranulation - Date: 1999, Sep 22 From: Ted Yeoman

Harris & Rolstad reported in "Hypergranulation Tissue: a nontraumatic method of management" (sorry I don't have the full ref to hand) Lyofoam ( SSL International) is an effective non-traumatic method for reducing overgranulation. I must declare an interest tho, I am employed by SSL International. There are several other case studies confirming this conclusion.

Causes of and Solutions to Hypergranulation Re: Hypergranulation - (Ted Yeoman) Date: 1999, Sep 23 From: Amanda Woodcock

Hi Donna - In the same way that new seedlings search for light, it is thought that granulation tissue may search for oxygen. It has been suggested that high moisture and low oxygen levels can stimulate granulation tissue formation and for this reason, some companies advocate the use of occlusive dressings to encourage granulation tissue formation. If this theory is correct, then the converse environment may be a possible solution for hypergranulation - relatively increased oxygen levels and lower moisture levels. This could be the reason why hypergranulation sometimes resolves under a more breathable dressing where previously an occlusive dressing was used. This is one of the solutions proposed by Christine Moffatt and Peter Harper in their book "Leg Ulcers": ISBN 0 443 05533 5 (1997) Together with the option of a more permeable dressing, they suggest light, local pressure or, in extreme cases (and under medical supervision) corticosteroid cream or silver nitrate pencil (75%). Amanda Woodcock Clinical Research Manager Molnlycke Health Care, Dunstable, UK

Hypergranulation Re: Hypergranulation - (Ted Yeoman) Date: 1999, Sep 24 From: Marie

Hello Donna! I have often found a less occlusive environment suitable for reducing hypergranulation. Lyofoam has also been used with success. For stubborn cases, a corticosteroid cream such as Teracortil has been prescribed with excellent results. Good Luck,    Marie.

Hypergranulation and the use of corticosteroids. Re: Hypergranulation - (Marie) Date: 2000, Jun 18 From: Emma Beesley

I have read articles which briefly discuss the use of corticosteroid creams in the treatment of hypergranulation, but have been unable to find any concrete research about this. Has anybody done any research or know where I can gather more evidence for its use. Emma.

Full Reference For Lyofoam Re: Hypergranulation - (Ted Yeoman) Date: 2000, Jan 09 From: Ted Yeoman

Hi Donna The full reference for the Lyofoam work mentioned above is:- Harris A, Rolstad BS (1992) Hypergranulation tissue: a non traumatic method of management. 3rd European Conference on Advances in Wound Management Proceedings, Macmillan Magazines, London. Amanda's answer descibes the theory of Hypergranulation in an ellegent way using the same model as I use when asked about the problem.

Untitled Re: re: hypergranulation - Date: 2000, Dec 07 From: <peterhider at onetel.co.uk>

Have you tried Terr-cortril

Untitled Date: 1999, Sep 22 From: olli

I attended a wound conference today and there was discussion regarding hypergranulation. There were 3 suggestions 1. to apply pressure with rolled gauze. 2. apply pressure with the fingertips to the tissue in question 3. use silvernitrate stick to tissue. I have used silver nitrate sticks successfully, have not tried 1 or 2

hypergranulation Date: 1999, Sep 22 From: Luk De Crom

Hello Donna, Have you already changed your local-basic therapy? I made good experiences by using an alginate (i.e. Tegagen 3M) in combination with a transparent film (i.e. Tegaderm 3M). This combination is less "active" as an hydrocolloïd and reduce the prevalence of hypergranulation. Complementary to this, I use compression to rebuild hypergranulated tissues. bye Luk De Crom

Hypergranulation Date: 1999, Sep 22 From: Ted Yeoman

Harris & Rolstad reported in "Hypergranulation Tissue: a nontraumatic method of management" (sorry I don't have the full ref to hand) Lyofoam ( SSL International) is an effective non-traumatic method for reducing overgranulation. I must declare an interest tho, I am employed by SSL International. There are several other case studies confirming this conclusion.

Causes of and Solutions to Hypergranulation Re: Hypergranulation - (Ted Yeoman) Date: 1999, Sep 23 From: Amanda Woodcock

Hi Donna - In the same way that new seedlings search for light, it is thought that granulation tissue may search for oxygen. It has been suggested that high moisture and low oxygen levels can stimulate granulation tissue formation and for this reason, some companies advocate the use of occlusive dressings to encourage granulation tissue formation. If this theory is correct, then the converse environment may be a possible solution for hypergranulation - relatively increased oxygen levels and lower moisture levels. This could be the reason why hypergranulation sometimes resolves under a more breathable dressing where previously an occlusive dressing was used. This is one of the solutions proposed by Christine Moffatt and Peter Harper in their book "Leg Ulcers": ISBN 0 443 05533 5 (1997) Together with the option of a more permeable dressing, they suggest light, local pressure or, in extreme cases (and under medical supervision) corticosteroid cream or silver nitrate pencil (75%). Amanda Woodcock Clinical Research Manager Molnlycke Health Care, Dunstable, UK

Hypergranulation Re: Hypergranulation - (Ted Yeoman) Date: 1999, Sep 24 From: Marie

Hello Donna! I have often found a less occlusive environment suitable for reducing hypergranulation. Lyofoam has also been used with success. For stubborn cases, a corticosteroid cream such as Teracortil has been prescribed with excellent results. Good Luck,    Marie.

Hypergranulation and the use of corticosteroids. Re: Hypergranulation - (Marie) Date: 2000, Jun 18 From: Emma Beesley

I have read articles which briefly discuss the use of corticosteroid creams in the treatment of hypergranulation, but have been unable to find any concrete research about this. Has anybody done any research or know where I can gather more evidence for its use. Emma.

Full Reference For Lyofoam Re: Hypergranulation - (Ted Yeoman) Date: 2000, Jan 09 From: Ted Yeoman

Hi Donna The full reference for the Lyofoam work mentioned above is:- Harris A, Rolstad BS (1992) Hypergranulation tissue: a non traumatic method of management. 3rd European Conference on Advances in Wound Management Proceedings, Macmillan Magazines, London. Amanda's answer descibes the theory of Hypergranulation in an ellegent way using the same model as I use when asked about the problem.

are there any journal articles which drescribe the best outcome in the management of hypergranulation Re: Hypergranulation - (Ted Yeoman) Date: 2000, Sep 10 From: <s.dixon at net2000.com.au>

Does anyone know of a foolproof, easy method of managing hypergranulation in relation to PEG and Tracheostomy sites?

Causes of and Solutions to Hypergranulation Date: 1999, Sep 23 From: Amanda Woodcock

Hi Donna - In the same way that new seedlings search for light, it is thought that granulation tissue may search for oxygen. It has been suggested that high moisture and low oxygen levels can stimulate granulation tissue formation and for this reason, some companies advocate the use of occlusive dressings to encourage granulation tissue formation. If this theory is correct, then the converse environment may be a possible solution for hypergranulation - relatively increased oxygen levels and lower moisture levels. This could be the reason why hypergranulation sometimes resolves under a more breathable dressing where previously an occlusive dressing was used. This is one of the solutions proposed by Christine Moffatt and Peter Harper in their book "Leg Ulcers": ISBN 0 443 05533 5 (1997) Together with the option of a more permeable dressing, they suggest light, local pressure or, in extreme cases (and under medical supervision) corticosteroid cream or silver nitrate pencil (75%). Amanda Woodcock Clinical Research Manager Molnlycke Health Care, Dunstable, UK

Hypergranulation Date: 1999, Sep 24 From: Marie

Hello Donna! I have often found a less occlusive environment suitable for reducing hypergranulation. Lyofoam has also been used with success. For stubborn cases, a corticosteroid cream such as Teracortil has been prescribed with excellent results. Good Luck,    Marie.

Hypergranulation and the use of corticosteroids. Re: Hypergranulation - (Marie) Date: 2000, Jun 18 From: Emma Beesley

I have read articles which briefly discuss the use of corticosteroid creams in the treatment of hypergranulation, but have been unable to find any concrete research about this. Has anybody done any research or know where I can gather more evidence for its use. Emma.

Hi Volt information needed Date: 1999, Sep 21 From: Cathy

I need scientific studies on the use of Hi Volt electical stimulation used to help heal diabetic ulcers. I have the studies on the use of Hi Volt on pressure ulcers, but the doctor I'm am talking with wants scientific studies on diabetic ulcers. Any help would be appreciated!

Untitled Re: Hi Volt information needed - (Cathy) Date: 1999, Dec 19 From: Chan

Hi Cathy We are currently in the process of evaluating a portable hi voltage device,we have treated a level 4 ulcer non healing for approx 6 years,so far 90% healed,a diabetic ulcer non healing 70% healed in within 4 treatments,my E mail ad in Aus feroxin at powerup .com.au,you are searching in the right direction. Regards chan

Untitled Date: 1999, Dec 19 From: Chan

Hi Cathy We are currently in the process of evaluating a portable hi voltage device,we have treated a level 4 ulcer non healing for approx 6 years,so far 90% healed,a diabetic ulcer non healing 70% healed in within 4 treatments,my E mail ad in Aus feroxin at powerup .com.au,you are searching in the right direction. Regards chan

Problems with some of our web pages ? Date: 1999, Sep 22 From: Pete Phillips

I have had some email saying that some of the pages on World Wide Wounds are problematic on MS Internet Explorer. For example, on the Question and Answer page , some browsers appear to lose the first letter of the headings. Could readers of this forum please send me details of the browser (MSIE, Netscape, lynx etc), and the version you are using, and the OS you are using it under (Win 95, Win 98, etc), and whether or not you see this problem ? I would like to nail this, as the pages have tested out OK with various HTML compliance tools. thanks in advance Pete Phillips - SMTL Webmaster

Silver Sulphadiazine Date: 1999, Sep 22 From: Pete Phillips

Someone asked this question last year in World Wide Wounds Question and Answer section. Does anyone have any comments on this ? QUESTION: When is it appropriate to use silver sulphadiazine (Silvadene/Flamazine) in wound care? I find many doctors using it, but they can't really tell me why. I have had one answer as follows: ANSWER:"It is only FDA approved in the USA for use in burns. I find betadine gel works just as good if not better in burns(there are studies to back this up). Plus, silvadene has been shown to give rise to resistant strains of bacteria. I refuse to use the stuff. I find that most people use it for the wrong reason and end up macerating the wound."

Silver sulphadiazine Re: Silver Sulphadiazine - (Pete Phillips) Date: 1999, Sep 22 From: Rae Johnson

I have used Silvazine, a product which contains chlorhexadine for 20 years. The other products are essentially the same without the chlorhexadine component. The antibacterial action is mainly through the silver, and improved by the sulphur and chlorhexadine. I use it for the following wounds. 1. Used in burns to reduce the bacterial numbers colonizing the eschar. Silvazine maintains eschar "intact" untill such time that it is surgically debrided and grafted. If the eschar becomes highly colonised, the acidic nature of the highly exudating wound reduces the ability of the graft to adhere to the wound bed and the graft is digested by the enzymatic process. 2. A diabetic patient with a partial or deep partial burn. These wounds get overwhelmed with the normal colonization process and often become clinically infected. Use for 5-7 days until all redness is resolved. Then promote separtion of slough/eschar and epithelialisation through wound management or surgical intervention. 3. Dirty or infected wounds, or wounds in certain sites such as genetalia or axillas. Once the wound is clean, then promote separation of devitalised tissue and then promote epithelialisation. I change the dressing daily or prn in genitalia. It is impregnated into a chux-like material, 2 layers thick, 2-3 mm thick followed by a secondary dressing. I've used this product for 20 years without any problems of resisance, however I have seen sensitivity to it but only after a extended period of application to an area where it should have been ceased once the wound was clean. It has been demonstrated to inhibit healing but then there are certain times when the use of these agents is required so that the wound can move onto to the next phase.

Untitled Re: Silver Sulphadiazine - (Pete Phillips) Date: 1999, Sep 23 From: Brenda Ramstadius

I (in Australia), like Rae Johnson, use Silvazene in selected patients. Unfortunately, I find many clinicians do not understand what their objective of management is when it comes to wound care. Moist wound healing products are most appropriate in most situations but there are patients whose wounds may not progress to wound closure eg tumours, diabetic foot wounds, etc where it is not appropriate to continually use an expensive dressing regime when the outcome "wound closure" is not possible. Silvazene therefore can become a cost effective, soothing regime which is painless to remove in comparison to moist wound healing products or antiseptics & dry dressing use. I have used Silvazene on painful diabetic foot wound gangrene prior to surgical intervention when other clinicians wanted to use Alginates...these would have been expensive & painful to remove & would not have provided any greater benefit to the wound. The objective in this case was palliative managment of the wound prior to surgical intervention whilst also reducing the bacterial load of the wound. Some clinicians also wanted to use Hydrogels in this instance, but whilst it would have been painless to remove it offered no protection from increasing bacterial colonisation in a wound which was lacking in blood supply & at grave risk for infection.....Wound Care is about individual assessment & the objectives of management for the wound whilst reducing patient discomfort. Other clinical examples eg 1.extensive bilateral limb venous insufficiency ulcers, heavily crusted & infected with pseudomonas in a sedentry, morbidly obese patient....Silvazene excellent for cleaning up area, impregnated the Silvazene into Chux like towels (as Rae Johnson does), (with mild compression) easy application for clinician, soothing for patient, legs improved within a week of application then reverted to full 4 layer compression only. 2.extensive cellulits, weeping of a lower limb...painful , copious fluid exudation from area - used Silvazene impregnated into Chux like towels as above with incontinence pads used as absorbent layer with crepe bandage over,again soothing for patient & easy for clinician to apply. I would not use Silvazene routinely for all patients (exception burns) but it is a significantly helpful product in the "right" circumstance. I prefer this regime to applying painful antiseptic packing regimes to patients...I actually refuse to follow orders such as "Betadine packs".

Silver Sulphadiazine in Partial Thickness Burns Re: Silver Sulphadiazine - (Pete Phillips) Date: 1999, Sep 23 From: Amanda Woodcock

Silver sulphadiazine is commonly used on non-infected wounds to prevent infection. It appears that the eschar formed by silver sulphadiazine could affect the rate of healing. Catherine Gotschall (ScD), Maria Morrison (RN) and Martin Eichelberger (MD) - Washington, USA, compared silver sulphadiazine (Silvadene) with a soft silicone wound contact dressing (Mepitel) in non-infected paediatric partial thickness burns - with the following outcomes: 1. A faster healing time for the Mepitel group (p < 0.001) 2. Less eschar in the Mepitel group (p < 0.05) 3. Less pain at dressing changes in the Mepitel group (p < 0.05) 4. Lower mean daily hospital charges in the Mepitel group (p = 0.025) 5. No difference in the clinical infection rates Mepitel does not have an antibacterial action. It comprises soft silicone gel coated onto a flexible polyamide net. The dressing is hydrophobic and, while it adheres gently to dry skin, it does not adhere to moist surfaces. The healing times for acute wounds dressed with this soft silicone wound contact dressing are in line with those for technical dressings deemed to provide a "moist wound healing" environment. The outcomes of this study have been repeated. This study can be found in the Journal of Burn Care and Rehabilitation Volume 19, Number 4 1998. Amanda Woodcock Clinical Research Manager Molnlycke Health Care Ltd, Dunstable, UK.

silver sulphadiazine and ions in hair folicles Re: Silver Sulphadiazine - (Pete Phillips) Date: 1999, Oct 12 From: louise gibson

Hi There, Does anyone have information/research regarding Flamazine/Bactrazine (Silver Sulphadiazine) causing secondary inflammatory response around the hair folicles, due to the silver ions. Many thanks Louise

Silver sulphadiazine Date: 1999, Sep 22 From: Rae Johnson

I have used Silvazine, a product which contains chlorhexadine for 20 years. The other products are essentially the same without the chlorhexadine component. The antibacterial action is mainly through the silver, and improved by the sulphur and chlorhexadine. I use it for the following wounds. 1. Used in burns to reduce the bacterial numbers colonizing the eschar. Silvazine maintains eschar "intact" untill such time that it is surgically debrided and grafted. If the eschar becomes highly colonised, the acidic nature of the highly exudating wound reduces the ability of the graft to adhere to the wound bed and the graft is digested by the enzymatic process. 2. A diabetic patient with a partial or deep partial burn. These wounds get overwhelmed with the normal colonization process and often become clinically infected. Use for 5-7 days until all redness is resolved. Then promote separtion of slough/eschar and epithelialisation through wound management or surgical intervention. 3. Dirty or infected wounds, or wounds in certain sites such as genetalia or axillas. Once the wound is clean, then promote separation of devitalised tissue and then promote epithelialisation. I change the dressing daily or prn in genitalia. It is impregnated into a chux-like material, 2 layers thick, 2-3 mm thick followed by a secondary dressing. I've used this product for 20 years without any problems of resisance, however I have seen sensitivity to it but only after a extended period of application to an area where it should have been ceased once the wound was clean. It has been demonstrated to inhibit healing but then there are certain times when the use of these agents is required so that the wound can move onto to the next phase.

Untitled Date: 1999, Sep 23 From: Brenda Ramstadius

I (in Australia), like Rae Johnson, use Silvazene in selected patients. Unfortunately, I find many clinicians do not understand what their objective of management is when it comes to wound care. Moist wound healing products are most appropriate in most situations but there are patients whose wounds may not progress to wound closure eg tumours, diabetic foot wounds, etc where it is not appropriate to continually use an expensive dressing regime when the outcome "wound closure" is not possible. Silvazene therefore can become a cost effective, soothing regime which is painless to remove in comparison to moist wound healing products or antiseptics & dry dressing use. I have used Silvazene on painful diabetic foot wound gangrene prior to surgical intervention when other clinicians wanted to use Alginates...these would have been expensive & painful to remove & would not have provided any greater benefit to the wound. The objective in this case was palliative managment of the wound prior to surgical intervention whilst also reducing the bacterial load of the wound. Some clinicians also wanted to use Hydrogels in this instance, but whilst it would have been painless to remove it offered no protection from increasing bacterial colonisation in a wound which was lacking in blood supply & at grave risk for infection.....Wound Care is about individual assessment & the objectives of management for the wound whilst reducing patient discomfort. Other clinical examples eg 1.extensive bilateral limb venous insufficiency ulcers, heavily crusted & infected with pseudomonas in a sedentry, morbidly obese patient....Silvazene excellent for cleaning up area, impregnated the Silvazene into Chux like towels (as Rae Johnson does), (with mild compression) easy application for clinician, soothing for patient, legs improved within a week of application then reverted to full 4 layer compression only. 2.extensive cellulits, weeping of a lower limb...painful , copious fluid exudation from area - used Silvazene impregnated into Chux like towels as above with incontinence pads used as absorbent layer with crepe bandage over,again soothing for patient & easy for clinician to apply. I would not use Silvazene routinely for all patients (exception burns) but it is a significantly helpful product in the "right" circumstance. I prefer this regime to applying painful antiseptic packing regimes to patients...I actually refuse to follow orders such as "Betadine packs".

Silver Sulphadiazine in Partial Thickness Burns Date: 1999, Sep 23 From: Amanda Woodcock

Silver sulphadiazine is commonly used on non-infected wounds to prevent infection. It appears that the eschar formed by silver sulphadiazine could affect the rate of healing. Catherine Gotschall (ScD), Maria Morrison (RN) and Martin Eichelberger (MD) - Washington, USA, compared silver sulphadiazine (Silvadene) with a soft silicone wound contact dressing (Mepitel) in non-infected paediatric partial thickness burns - with the following outcomes: 1. A faster healing time for the Mepitel group (p < 0.001) 2. Less eschar in the Mepitel group (p < 0.05) 3. Less pain at dressing changes in the Mepitel group (p < 0.05) 4. Lower mean daily hospital charges in the Mepitel group (p = 0.025) 5. No difference in the clinical infection rates Mepitel does not have an antibacterial action. It comprises soft silicone gel coated onto a flexible polyamide net. The dressing is hydrophobic and, while it adheres gently to dry skin, it does not adhere to moist surfaces. The healing times for acute wounds dressed with this soft silicone wound contact dressing are in line with those for technical dressings deemed to provide a "moist wound healing" environment. The outcomes of this study have been repeated. This study can be found in the Journal of Burn Care and Rehabilitation Volume 19, Number 4 1998. Amanda Woodcock Clinical Research Manager Molnlycke Health Care Ltd, Dunstable, UK.

silver sulphadiazine and ions in hair folicles Date: 1999, Oct 12 From: louise gibson

Hi There, Does anyone have information/research regarding Flamazine/Bactrazine (Silver Sulphadiazine) causing secondary inflammatory response around the hair folicles, due to the silver ions. Many thanks Louise

Silver sulphadiazine Date: 1999, Dec 10 From: Simon Whitfield

Silver sulphadiazine is a broad spectrum antibacterial effective at reducing bacterial numbers in infected wounds including those contaminated by MRSA. Its main indication is to reduce the risks of wound sepsis but there has been some evidence published that it can promote faster healing - Bishop JB, Vasc Surg (1992) 16 (2) 251-257 - Geronemus et al, Arch dermatol 1979 (115) 1311-1314 Licenced indications include burns, leg ulcers, pressure ulcers and finger-tip injuries with numerous publications demonstrating efficacy.

Untitled Date: 2000, Jan 05 From: <Anonymous>

In the Uk Silver sulphadiazine ( commonly known as Flammazine from Smith and Nephew) has been superseded by Flammercerium (produced by Solvey) which contains cerium nitrate in combination with Silver sulphadiazine This has a wider antibacterial effect forms a soft eschar, does not mask wound depth and can be left intact for three days. unfortunately It can only be used in burns units as it has to be prescribed on a named patient basis Much of last years European burns association meeting was spent looking at comparisons of Flammerceru=ium against other treatments used in burns.. NB Silver Suphadiazine should only be used in Full thickness injuries. if any one disagrees I would love to discuss it!

full thickness only? Re: Untitled - Date: 2000, Feb 20 From: Chan

Why do you say that SSD is for full thickness wounds only? What are then effects for applying it to partial thickness wounds? Appreciate your comments.

Why not to use betadine in cavity wounds Date: 1999, Sep 23 From: Lynne Gill

I am looking for information on why not to use betadine in cavity wounds and problems and advantages of using iodine based preparations on acute and chronic wounds

octenisept instead of betadine Re: Why not to use betadine in cavity wounds - (Lynne Gill) Date: 1999, Sep 23 From: Luk De Crom

Hello, If my Informations are right, betadine (iodine) is a very good local desinfectans for short applies (5-10 minutes) - unfortunaly it even has a toxic effect on the granulozytes which means that it can't be used for continuous desinfection (i.e. 24h a day) which may be usefull in fall of an infected wound. That means that after applying betadine a good cleaning with i.e. NaCl 0.9% is indicated by chronic wounds. Mostly I use Octenisept (octenidini dihydrochloridum) instead of betadine which is also again gram positvs and covers a large spectrum of bacteries. That you should not use betadine in cavity wounds is new for me but I explain it like follwing. The risk you don't retire the whole betadine is great and then its toxic for the granulozytes so it is better use another desinfectans. greetings Luk De Crom

betadine Re: octenisept instead of betadine - (Luk De Crom) Date: 2000, Dec 05 From: aulia

Betadine use in wounds Re: Why not to use betadine in cavity wounds - (Lynne Gill) Date: 1999, Sep 24 From: olli

Betadine in a wound is contra indicated because it destroys fibroblasts and healthy tissue. There are several studies which suppport this. In the A.H.C.P.R guidlines {Agency for Health Care policy and Research)it is recommended that it not be used. This is written by the National Pressure Ulcer Advisory Committee and is considered "the Bible" of wound care in the States. Despite these recommendations we still have physicians who order it. I have also seen quite nasty looking burns to the peri ulcer area after repeated use.

Betadine is cytotoxic Re: Betadine use in wounds - (olli) Date: 1999, Oct 09 From: Catherine

The use of betadine in wounds slows healing and in documented cases has caused injury and death. An earlier writer, Ollie, noted the AHCPR Guidelines for the Treatment of Wounds advises against the use of betadine. A couple of years ago my colleagues and I did an extensive literature review on the use of betadine in wounds, most of the studies that supported the use of betadine for wounds were written by or supported by the manufacturers of povidone-iodine. In 1989, Dr. George Rodeheaver,wrote Controversies in Topical Wound Management. (Wounds: A Compendium of Clinical Research and Practice Vol. 1, No. 1.) In the article he notes that not only is betadine cytotoxic, but that wounds treated with betadine had an increased number of infections. In the article Dr. Rodeheaver describes a report published by Dr. Gary Becker. There were 35 patients with contaminated head and neck surgery cases. "In 18 of those patients just prior to closure, he had irritaged the wunds with povidone-iodine in the other 17 patients he irrigated with isotonic saline. Of the 28% of the study group that developed a wound infection all had been treated with povidone-iodine. Dr. Rodeheaver also reports of an animal study by Brennan and Leaper. A rabbit ear model was treated with a 1:1 dilution of povidone-iodine which resulted in the complete cessation of blood flow in the capillary bed. Since a pressure ulcer is the result of an ischemic event, this study indicates that the use of 1:1 dilution of povidone-iodone in a pressure ulcer could result in the "complete cessation of blood flow". Another article, reports of a patient who had a hip repair surgery and developed an incisional wound. The orders were to irrigate the wound with betadine and then pack the wound with betadine satuated gauze, the patient went into renal failure, the patient was found to have toxic iodine levels, and later died. Kaup R. Shetty, and Edmund H Duthie,Jr., Thyrotoxicosis Induced by Topical Iodine Application. Archive of Internal Medicine,Vol 150, November 1990. Shetty and Duthie note that regardless of the route increased iodine availability can result in iodine induced thyrotoxicosis. I hope this helps Catherine

betadine swab for dry eschar Re: Betadine use in wounds - (olli) Date: 2001, Apr 13 From: laurie

I am looking for a reference for using betadine swab to dry eschar on toes to decrease the bacterial load. I can not find a reference to this in the AHCPR guidelines. I know it is common practice, but I can not find documented support. Does anyone know of a place I can look?? Thanks!!

Untitled Re: Why not to use betadine in cavity wounds - (Lynne Gill) Date: 1999, Sep 24 From: Nicky Perkins

Hi, AS far as i know betadine is not licenced in the UK for open wounds and i find it increasinly worrying that surgeans still use it when there is evidence to sugest that it damages granulating tissue and prolongs the inflammatory response. Given the choice any wound care professional should steer well clear of this substance.

You Can Re: Why not to use betadine in cavity wounds - (Lynne Gill) Date: 1999, Sep 30 From: Ted Yeoman

First declare an interest, SSL Int., my employers manufacture and sell Betadine. I refer you to:- 1 Elenor Davis, Don't Deny The Chance to Heal. 2nd Joint Meeting of The Wound Healing Society and The European Tissue Repair Society, Boston USA 1996. 2 B Gilchrist, on behalf of the European Tissue Repair Soc., Should iodine be recosidered in wound management? Journal of Wound Care, vol6,No3,1997. Which concludes "Should iodine be reconsidered? The unanimous consensus is yes."

Povidone-iodine toxicity. Re: Why not to use betadine in cavity wounds - (Lynne Gill) Date: 1999, Nov 21 From: Donald Saye, DPM,CWS

Povidone-iodine in large wounds has caused death from iodine toxicity, but I could not find that specific reference. It may be helpful to read the following references: 1.Zamora JL. Chemical and microbiologic characteristics and toxicity of povidone-iodine solutions. Am J Surgery1986;151:400-406 2.Lammers RL, et al. Effect of povidone-iodine and saline soaking on bacterial counts in acute, traumatic contaminated wounds. Ann Emergency Medicine 1990;19:709-714 3.Lineaweaver W, et al. Topical antimicrobial toxicity. Arch Surg 1985;120:267-270 4. Brennan SS, Leaper DJ.The effect of antiseptics on the healing wound: a study using the rabbit ear chamber. Br J Surg 1985;10:780-782 5. Dire DJ, et al. A comparison of wound irrigation solutions used in the emergency department. Ann Emerg Med 1990;19:704-708 5. Kjolseth D, et al. Comparison of the effects of commonly used wound agents on epithelialization and neovascularization. Am College Surgery 1994;179:305-312 6. Lineaweaver W, et al. Topical antimicrobial toxicity. Arch Surgery 1985;120:267-270 7. Terleckyj B, et al. Antiseptics and disinfectants. JAPMA 1995;85:439-445 8. Mertz, PM, et al. A new in vivo model for the evaluation of topical antiseptics on superficial wounds. Arch Dermatology 1984;120:58-62 You should also read a letter to the editor in Wounds, pA12-A14(I do not know which year or volume) from Janet Welch, Associate Director Medical Services and Drug Surveillance, The Purdue Frederick Co. in response to an article by Patricia Mertz. There is a response to the letter by Patricia Mertz. There is also a reference to another letter to the editor in ONF 1991;18(4):68-59-660 by Janet Welch. I hope the above helps. Don Saye

videne Re: Povidone-iodine toxicity. - (Donald Saye, DPM,CWS) Date: 2000, Nov 08 From: cristina dolcetti

anybody has information on the new povidone iodine based product "Videne"? Thanks.

Saline gels Date: 1999, Sep 24 From: <cindy at busynet.net>

Has anyone had experience with saline gels replacing enzymatic debriding agents in stage lll and lV ulcers? I'm relatively new to this field and learning a great deal from this web site. thanks cindy

Hypertonic Saline Gel for Debridement of Eschar Re: Saline gels - Date: 1999, Sep 24 From: Amanda Woodcock

Hi Cindy Etris Associates, Inc, Stanfield & Associates, Connecticut Clinical Nurse Associates, ET Nurse Enterprises and Bryant Rolstad Consultants performed a randomised, controlled, comparative clinical study to evaluate the effectiveness of a Hypertonic Saline Gel (Hypergel) and a Collagenase Enzymatic (Santyl) in debriding eschar on a variety of dermal ulcers. The outcomes of this study have been presented both orally and in poster form in the US. You can contact Joan Halpin-Landry at Molnlycke Health Care, 500 Baldwin Tower, Eddystone, PA 19022, for further information. Kind regards, Amanda Woodcock Clinical Research Manager Molnlycke Health Care, Dunstable, UK

Help please, "colsed presser ulcers", PU development time Date: 1999, Sep 24 From: Jill Thomas

I have been looking for references for closed pressure ulcers without sucess. Can anyone help?? I attended a seminar recently and was told that it can take up to 21 days for a pressure ulcer to develop from time of insult (ie, lying on OR table for extended of time) at the same seminar we were told that there was a 50/50 chance of pressure ulcer development (from original significant insult)vs. healing even if preventative measure are instituted. Any comments/information or references would be greatly appreciated. Thank you, Jill Thomas JillThomas at aol.com

References on the healing of pressure ulcers Re: Help please, "colsed presser ulcers", PU development time - (Jill Thomas) Date: 2000, Nov 07 From: Thomas A. Sharon, R.N., M.P.H.

There is much information in the medical literautre about the Diapulse Wound Treatment System. Randomized double blind clinical trials and clinical case studies have shown remarkable results in healing stage II's, III's and IV's. Key in "diapulse" on Medline for 28 citations. You can also go to http://nursetom.healthcareforums.com and http://www.diapulse.com for more info.

Cornified Hypergranulated Tissue Date: 1999, Sep 24 From: Kathy Williamson, BS, BSN, MSM

68yo black male who presented to our clinic with venous stasis ulcers bilaterally and had been treated with unna boots. When the boots were removed, there was extensive ulceration, scaley skin on the skins and top of the feet, and thick yellow cornified skin surrounding the heels. We have resolved all issues with the exception of the cornified skin. We have tried saline soaks, vaseline, aggressive debridement and this has done nothing. Any suggestions on how we can get rid of the cornified skin? All suggestions welcomed and needed ASAP! Thanks, Kathy

Community Nurse RGN Re: Cornified Hypergranulated Tissue - (Kathy Williamson, BS, BSN, MSM) Date: 1999, Sep 24 From: Nicky Perkins

Re Cornified skin if you mean hard dry skin try 50/50 soft white parrafin and liquid parrafin mix. i have found this most helpfull in rehydrating varicosr exzema patients

granulated sugar in cavity wounds Date: 1999, Sep 24 From: Maria

In Brasil, many people still use dressings with granulated sugar in wounds (like stage IV pressure ulcer) when the patients cannot afford any other kind of material and the ulcer has slough material and foul odor. The dressing is changed at least 2 times a day as it gets soaked. I have read about hypertonic saline gel and I am wondering if the principles are the same. Is it a research based practice? Thanks. Maria

Sugar Re: granulated sugar in cavity wounds - (Maria) Date: 1999, Oct 07 From: Wayne Naylor

Hi Maria You may be interested to know that sugar was one of the first wound dressings used in recorded history. Sugar and honey were probably used as dressing about 4000 years ago. There has been renewed interest recently in their use in wound management, particularly in infected wounds. They appear to exert their effects on wound healing due to their high osmolarity which prevents certain bacteria from growing. In the case of honey, the low pH and the presence of antibacterial substances also has an effect. Granulated sugar is not the ideal form of sugar to use as it may produce an intense burning sensation when applied directly to an open wound as it draws up wound exudate. The use of a sugar paste is recommended to prevent this. In this form it also keeps the wound bed moist thereby promoting the natural healing process. There is a reasonable amount of research around at the moment about sugar paste and honey use and there is a very interesting article in SMTL's Dressings Times recounting the experience of sugar paste use in Zanzibar. It is available at this web site http://www.smtl.co.uk/WMPRC/DressingsTimes/vol4.3.txt Here are some other references. Cooper, R. and Molan, P. (1999) The use of honey as an antiseptic in managing Pseudomonas infection. Journal of Wound Care 8(4), 161-164. Miller, M. and Glover, D. (1999) Wound Management. Nursing Times Books, London I hope this is helpful. Wayne :-)

Another good reference Re: Sugar - (Wayne Naylor) Date: 1999, Oct 07 From: Wayne

This is another interesting article in the Dressings Times http://www.smtl.co.uk/WMPRC/DressingsTimes/vol3.2.txt

Why not to use Hydrogen peroxide for wound cleansing? Date: 1999, Sep 25 From: Sharon Radcliffe

I am seeking information as to why hydrogen peroxide should not be used for cleaning wounds and/or for using to saturate gauze as a wound packing. I work at a small hospital in the Caribbean and it is proving difficult to influence the medical staff that this practice should be abandoned. They particularly like using if to ward against'infection'

Hydrogen Peroxide is unsuitable for use in wounds. Re: Why not to use Hydrogen peroxide for wound cleansing? - (Sharon Radcliffe) Date: 1999, Nov 21 From: Donald Saye, DPM,CWS

Please refer to the following references: 1.Lineaweaver W., et al. Topical antimicrobial toxicity. Arch Surg 1985;120:267-270 2. O'toole EA, et al. Hydrogen peroxide inhibits human keratinocyte migration.Dermatologic Surgery 1996;22:525-529 3. McKenna PJ, et al. Antiseptic effectiveness with fibroblast preservation. Ann Plastic Surgery 1991;27:265-268 I hope the above are useful. Don Saye

Hydrogen peroxide use on a degloved wound Re: Why not to use Hydrogen peroxide for wound cleansing? - (Sharon Radcliffe) Date: 2000, Jun 05 From: Joni Dunn

What complications can arrise when using over the counter hydrogen on a wound that has become degloved?

... Re: Why not to use Hydrogen peroxide for wound cleansing? - (Sharon Radcliffe) Date: May 31, 22:26 From: <stevecass18 at comcast.net>

YOu suck

Help! Images/pictures of wounds Date: 1999, Sep 25 From: Sharon Radcliffe

I am an RGN working in a small hospital in the Caribbean. I am organising some lectures on wound healing and dressing in an attempt to provide up to date wound care education. I am in need of some images/pictures of various types of wound for my lectures - infected, necrotic, sloughy, Granulating, epithelialising, venous ulcers, arterial ulcers and malignant. Can alnyone help me?

wound photos Re: Help! Images/pictures of wounds - (Sharon Radcliffe) Date: 1999, Sep 27 From: Maria

We have a page related to pressure ulcer prevention and management in our shool of nursing home page. It is not done yet as we have to correct a lot of thing. We do have some pictures from my research that you can use for your lecture. Bye, Maria

suggestions for pictures Re: Help! Images/pictures of wounds - (Sharon Radcliffe) Date: 1999, Sep 29 From: <howsonk at mpx.com.au>

Sometimes the wound care product companies are willing to help for education purposes - It worthwhile approaching the representative in you area for assistance. They also sometimes have the images as clipart so you can use them in aword processor or a power point presentation. I haven't tried it but I wonder if there are images on other websites - start by trying the compny websites. Kate