Verbesserung der Wundheilung durch wassergefiltertes Infrarot A (wIRA) bei Patienten mit chronischen venösen Unterschenkel-Ulzera einschließlich infrarot-thermographischer Beurteilung

Background: Water-filtered infrared-A (wIRA) is a special form of heat radiation with a high tissue-penetration and with a low thermal burden to the surface of the skin. wIRA is able to improve essential and energetically meaningful factors of wound healing by thermal and non-thermal effects. Aim of the study: prospective study (primarily planned randomised, controlled, blinded, de facto with one exception only one cohort possible) using wIRA in the treatment of patients with recalcitrant chronic venous stasis ulcers of the lower legs with thermographic follow-up. Methods: 10 patients (5 males, 5 females, median age 62 years) with 11 recalcitrant chronic venous stasis ulcers of the lower legs were treated with water-filtered infrared-A and visible light irradiation (wIRA(+VIS), Hydrosun® radiator type 501, 10 mm water cuvette, water-filtered spectrum 550–1400 nm) or visible light irradiation (VIS; only possible in one patient). The uncovered wounds of the patients were irradiated two to five times per week for 30 minutes at a standard distance of 25 cm (approximately 140 mW/cm2 wIRA and approximately 45 mW/cm2 VIS). Treatment continued for a period of up to 2 months (typically until closure or nearly closure of the ulcer). The main variable of interest was “percent change of ulcer size over time” including complete wound closure. Additional variables of interest were thermographic image analysis, patient’s feeling of pain in the wound, amount of pain medication, assessment of the effect of the irradiation (by patient and by clinical investigator), assessment of feeling of the wound area (by patient), assessment of wound healing (by clinical investigator) and assessment of the cosmetic state (by patient and by clinical investigator). For these assessments visual analogue scales (VAS) were used. Results: The study showed a complete or nearly complete healing of lower leg ulcers in 7 patients and a clear reduction of ulcer size in another 2 of 10 patients, a clear reduction of pain and pain medication consumption (e.g. from 15 to 0 pain tablets per day), and a normalization of the thermographic image (before the beginning of the therapy typically hyperthermic rim of the ulcer with relative hypothermic ulcer base, up to 4.5°C temperature difference). In one patient the therapy of an ulcer of one leg was performed with the fully active radiator (wIRA(+VIS)), while the therapy of an ulcer of the other leg was made with a control group radiator (only VIS without wIRA), showing a clear difference in favour of the wIRA treatment. All mentioned VAS ratings improved remarkably during the period of irradiation treatment, representing an increased quality of life. Failures of complete or nearly complete wound healing were seen only in patients with arterial insufficiency, in smokers or in patients who did not have venous compression garment therapy. Discussion and conclusions: wIRA can alleviate pain considerably (with an impressive decrease of the consumption of analgesics) and accelerate wound healing or improve a stagnating wound healing process and diminish an elevated wound exudation and inflammation both in acute and in chronic wounds (in this study shown in chronic venous stasis ulcers of the lower legs) and in problem wounds including infected wounds. In chronic recalcitrant wounds complete healing is achieved, which was not reached before. Other studies have shown that even without a disturbance of wound healing an acute wound healing process can be improved (e.g. reduced pain) by wIRA. wIRA is a contact-free, easily used and pleasantly felt procedure without consumption of material with a good penetration effect, which is similar to solar heat radiation on the surface of the earth in moderate climatic zones. Wound healing and infection defence (e.g. granulocyte function including antibacterial oxygen radical formation of the granulocytes) are critically dependent on a sufficient energy supply (and on sufficient oxygen). The good clinical effect of wIRA on wounds and also on problem wounds and wound infections can be explained by the improvement of both the energy supply and the oxygen supply (e.g. for the granulocyte function). wIRA causes as a thermal effect in the tissue an improvement in three decisive factors: tissue oxygen partial pressure, tissue temperature and tissue blood flow. Besides this non-thermal effects of infrared-A by direct stimulation of cells and cellular structures with reactions of the cells have also been described. It is concluded that wIRA can be used to improve wound healing, to reduce pain, exudation, and inflammation and to increase quality of life.Hintergrund: Wassergefiltertes Infrarot A (wIRA) ist eine spezielle Form der Wärmestrahlung mit hoher Gewebepenetration bei geringer thermischer Oberflächenbelastung. wIRA vermag über thermische und nicht-thermische Effekte wesentliche und energetisch bedeutsame Faktoren der Wundheilung zu verbessern. Ziel der Studie: prospektive Studie (primär randomisiert, kontrolliert, verblindet geplant, de facto mit einer Ausnahme nur eine Kohorte möglich) mit wassergefiltertem Infrarot A (wIRA) in der Therapie von Patienten mit therapierefraktären chronischen venösen Unterschenkel-Ulzera mit thermographischer Verlaufskontrolle. Methoden: 10 Patienten (5 Männer, 5 Frauen, Median des Alters 62 Jahre) mit 11 therapierefraktären chronischen venösen Unterschenkel-Ulzera wurden mit wassergefiltertem Infrarot A und sichtbarem Licht (wIRA(+VIS), Hydrosun®-Strahler Typ 501, 10 mm Wasserküvette, wassergefiltertes Spektrum 550–1400 nm) oder mit sichtbarem Licht (VIS; nur bei einem Patienten möglich) bestrahlt. Die unbedeckten Wunden der Patienten wurden zwei- bis fünfmal pro Woche über bis zu 2 Monate (typischerweise bis zum Wundschluss oder Fast-Wundschluss des Ulkus) für jeweils 30 Minuten mit einem Standardabstand von 25 cm bestrahlt (ungefähr 140 mW/cm2 wIRA und ungefähr 45 mW/cm2 VIS). Hauptzielvariable war die „prozentuale Änderung der Ulkusgröße über die Zeit“ einschließlich des kompletten Wundschlusses. Zusätzliche Zielvariablen waren thermographische Bildanalyse, Schmerzempfinden des Patienten in der Wunde, Schmerzmittelverbrauch, Einschätzung des Effekts der Bestrahlung (durch Patient und durch klinischen Untersucher), Einschätzung des Patienten des Gefühls im Wundbereich, Einschätzung der Wundheilung durch den klinischen Untersucher sowie Einschätzung des kosmetischen Zustandes (durch Patienten und durch klinischen Untersucher). Für diese Erhebungen wurden visuelle Analogskalen (VAS) verwendet. Ergebnisse: Die Studie ergab eine vollständige oder fast vollständige Abheilung der Unterschenkel-Ulzera bei 7 Patienten sowie eine deutliche Ulkusverkleinerung bei 2 weiteren der 10 Patienten, eine bemerkenswerte Minderung der Schmerzen und des Schmerzmittelverbrauchs (von z.B. 15 auf 0 Schmerztabletten täglich) und eine Normalisierung des thermographischen Bildes (vor Therapiebeginn typischerweise hyperthermer Ulkusrandwall mit relativ hypothermem Ulkusgrund, bis zu 4,5°C Temperaturdifferenz). Bei einem Patienten wurde ein Ulkus an einem Bein mit dem Vollwirkstrahler (wIRA(+VIS)) therapiert, während ein Ulkus am anderen Bein mit einem Kontrollgruppenstrahler (nur VIS, ohne wIRA) behandelt wurde, was einen deutlichen Unterschied zugunsten der wIRA-Therapie zeigte. Alle aufgeführten VAS-Einschätzungen verbesserten sich während der Bestrahlungstherapie-Periode sehr stark, was einer verbesserten Lebensqualität entsprach. Ein kompletter oder fast kompletter Wundschluss wurde nur bei Patienten mit peripherer arterieller Verschlusskrankheit, Rauchern oder Patienten mit fehlender venöser Kompressionstherapie nicht erreicht. Diskussion und Schlussfolgerungen: wIRA kann sowohl bei akuten Wunden als auch bei chronischen Wunden (in dieser Studie für chronische venöse Unterschenkelulzera gezeigt) und Problemwunden einschließlich infizierter Wunden Schmerzen deutlich mindern (mit eindrucksvoller Abnahme des Schmerzmittelverbrauchs) und die Wundheilung beschleunigen oder einen stagnierenden Wundheilungsprozess verbessern sowie eine erhöhte Wundsekretion und Entzündung mindern. Bei chronischen therapierefraktären Wunden werden vollständige Abheilungen erreicht, die zuvor nicht erreicht wurden. Andere Studien haben sogar ohne Wundheilungsstörung eine Verbesserung (z.B. Schmerzreduktion) der akuten Wundheilung durch wIRA gezeigt. wIRA ist ein kontaktfreies, verbrauchsmaterialfreies, leicht anzuwendendes, als angenehm empfundenes Verfahren mit guter Tiefenwirkung, das der Sonnenwärmestrahlung auf der Erdoberfläche in gemäßigten Klimazonen nachempfunden ist. Wundheilung und Infektionsabwehr (z.B. Granulozytenfunktion einschließlich antibakterieller Sauerstoffradikalbildung der Granulozyten) hängen ganz entscheidend von einer ausreichenden Energieversorgung (und von ausreichend Sauerstoff) ab. Die gute klinische Wirkung von wIRA auf Wunden und auch auf Problemwunden und Wundinfektionen lässt sich über die Verbesserung sowohl der Energiebereitstellung als auch der Sauerstoffversorgung (z.B. für die Granulozytenfunktion) erklären. wIRA bewirkt als thermischen Effekt im Gewebe eine Verbesserung von drei entscheidenden Faktoren: Sauerstoffpartialdruck im Gewebe, Gewebetemperatur und Gewebedurchblutung. Daneben wurden auch nicht-thermische Effekte von Infrarot A durch direkte Reizsetzung auf Zellen und zelluläre Strukturen mit Reaktionen der Zellen beschrieben. Es wird geschlossen, dass wIRA verwendet werden kann, um Wundheilung zu verbessern, Schmerzen, Sekretion und Entzündung zu reduzieren und die Lebensqualität zu steigern

DETECTION OF GRANULATION TISSUE FOR HEALING ASSESSMENT OF CHRONIC ULCERS

Wounds that fail to heal within an expected period develop into ulcers that cause severe pain and expose patients to limb amputation. Ulcer appearance changes gradually as ulcer tissues evolve throughout the healing process. Dermatologists assess the progression of ulcer healing based on visual inspection of ulcer tissues, which is inconsistent and subjective. The ability to measure objectively early stages of ulcer healing is important to improve clinical decisions and enhance the effectiveness of the treatment. Ulcer healing is indicated by the growth of granulation tissue that contains pigment haemoglobin that causes the red colour of the tissue. An approach based on utilising haemoglobin content as an image marker to detect regions of granulation tissue on ulcers surface using colour images of chronic ulcers is investigated in this study. The approach is utilised to develop a system that is able to detect regions of granulation tissue on ulcers surface using colour images of chronic ulcers

Improved Healing of Pressure Ulcers Using Dermapulse, A New Electrical Stimulation Device

A double-blind, clinical study of pulsed electrical stimulation using the Dermapulse® device was carried out on 40 pressure ulcers, randomized to receive either active (stim) or sham treatment. Electrodes were placed over saline-moistened gauze on the ulcers. An electrical current of 35mA was delivered to the wound tissues at a frequency of 128 pulses per second. Polarity was negative until the wound debrided, then alternated from .positive to negative every three days. Ulcers were treated for 30 minutes twice daily for four weeks, after which sham patients could cross over to active treatment, and stim patients could continue active treatment. Ulcer healing was determined by measuring the length and width of the ulcer and calculating the L x W product. The same clinicians measured the ulcers each week, were kept blinded to treatment group, and were not the same persons who applied the treatment. Nine centers treated 40 ulcers (19 sham and 21 stim). Analysis of the characteristics of the patients, the ulcers, and concomitant wound care by both univariate and multivariate analyses showed comparability of the groups. After four weeks, the stim ulcers healed more than twice as much as the sham ulcers (49.8% vs. 23.4%; (p = 0.042). The stim ulcers healed 12.5% per week compared to 5.8% for the sham group. In the 15 crossover patients, four weeks of active stimulation caused nearly four times as much healing as their four weeks of sham treatment (47.9% vs. 13.4%; p = 0.012). By the last week of-active stimulation they had healed an average of 64%, and complete healing occurred in 40% of these ulcers after an average of nine weeks. Seventeen of the active treatment ulcers had extended therapy, and by their last week of treatment had healed an average of 75%. Forty-one percent of these ulcers healed completely after an average of 11.8 weeks. There were no significant safety problems identified

Secondary bacterial infections of buruli ulcer lesions before and after chemotherapy with streptomycin and rifampicin

Buruli ulcer (BU), caused by Mycobacterium ulcerans is a chronic necrotizing skin disease. It usually starts with a subcutaneous nodule or plaque containing large clusters of extracellular acid-fast bacilli. Surrounding tissue is destroyed by the cytotoxic macrolide toxin mycolactone produced by microcolonies of M. ulcerans. Skin covering the destroyed subcutaneous fat and soft tissue may eventually break down leading to the formation of large ulcers that progress, if untreated, over months and years. Here we have analyzed the bacterial flora of BU lesions of three different groups of patients before, during and after daily treatment with streptomycin and rifampicin for eight weeks (SR8) and determined drug resistance of the bacteria isolated from the lesions. Before SR8 treatment, more than 60% of the examined BU lesions were infected with other bacteria, with Staphylococcus aureus and Pseudomonas aeruginosa being the most prominent ones. During treatment, 65% of all lesions were still infected, mainly with P. aeruginosa. After completion of SR8 treatment, still more than 75% of lesions clinically suspected to be infected were microbiologically confirmed as infected, mainly with P. aeruginosa or Proteus miriabilis. Drug susceptibility tests revealed especially for S. aureus a high frequency of resistance to the first line drugs used in Ghana. Our results show that secondary infection of BU lesions is common. This could lead to delayed healing and should therefore be further investigated

NURSING CARE FOR GRADE II DIABETIC ULCUS

Background –Uncontrolled diabetes mellitus will cause various complications, one of which is diabetic ulcers. The incidence of diabetic ulcers in DM patients is still high, namely in 2020 it has reached 25% throughout their lives. Patients will be susceptible to severe infections if they do not understand how to properly care for wounds, so that patients with diabetic ulcers can experience problems in the form of impaired tissue integrity. The development of wound care with modern dressing methods has become a trend now, because this wound treatment uses the moist concept so that it speeds up the wound drying process.Objectives –The case study aims to provide nursing care to patients with grade III diabetic ulcers with the main problem being impaired tissue integrity.Method –This type of case study uses a qualitative research design with a case study approach. The sample in this study consisted of 2 diabetic ulcer patients with conventional wound care for 6 days.Results –The results of case management for 6x8 hours showed that the wound condition had decreased in the BJWAT assessment score, but the wound healing process had not been resolved, namely patient 1 on the first day the BJWAT score was 38 then the sixth day it became 28 , while patient 2 on the first day was 39 then days sixth to 27. The wound healing process does take quite a long time, which can reach 12-20 weeks.Conclusion– The conclusion of this scientific paper is that after treating the wound using 0.9% NaCl solution compressed with metronidazole and gentamicin ointment for 6x8 hours, the wound healing process has not been resolved, but the BJWAT wound assessment score has decrease

Protocol for a pilot randomised controlled clinical trial to compare the effectiveness of a graduated three layer straight tubular bandaging system when compared to a standard short stretch compression bandaging system in the management of people with venous ulceration: 3VSS2008

<p>Abstract</p> <p>Background</p> <p>The incidence of venous ulceration is rising with the increasing age of the general population. Venous ulceration represents the most prevalent form of difficult to heal wounds and these problematic wounds require a significant amount of health care resources for treatment. Based on current knowledge multi-layer high compression system is described as the gold standard for treating venous ulcers. However, to date, despite our advances in venous ulcer therapy, no convincing low cost compression therapy studies have been conducted and there are no clear differences in the effectiveness of different types of high compression.</p> <p>Methods/Design</p> <p>The trial is designed as a pilot multicentre open label parallel group randomised trial. Male and female participants aged greater than 18 years with a venous ulcer confirmed by clinical assessment will be randomised to either the intervention compression bandage which consists of graduated lengths of 3 layers of elastic tubular compression bandage or to the short stretch inelastic compression bandage (control). The primary objective is to assess the percentage wound reduction from baseline compared to week 12 following randomisation. Randomisation will be allocated via a web based central independent randomisation service (nQuery v7) and stratified by study centre and wound size ≤ 10 cm²or >10 cm². Neither participants nor study staff will be blinded to treatment. Outcome assessments will be undertaken by an assessor who is blinded to the randomisation process.</p> <p>Discussion</p> <p>The aim of this study is to evaluate the efficacy and safety of two compression bandages; graduated three layer straight tubular bandaging (3L) when compared to standard short stretch (SS) compression bandaging in healing venous ulcers in patients with chronic venous ulceration. The trial investigates the differences in clinical outcomes of two currently accepted ways of treating people with venous ulcers. This study will help answer the question whether the 3L compression system or the SS compression system is associated with better outcomes.</p> <p>Trial Registration</p> <p>ACTRN12608000599370</p

DIGITAL IMAGE ULCER ASSESSMENT ON SMARTPHONES

Chronic ulcers can cause a severe pain to the patient. A digital image processing technique was currently used to monitor the healing progression of the ulcers patient in order to give a proper treatment. Red granulation tissue on an ulcer image is a healing indicator. Red granulation tissues contain a haemoglobin pigment reflecting the red colour of the tissue

Wound care in the geriatric client

With our aging population, chronic diseases that compromise skin integrity such as diabetes, peripheral vascular disease (venous hypertension, arterial insufficiency) are becoming increasingly common. Skin breakdown with ulcer and chronic wound formation is a frequent consequence of these diseases. Types of ulcers include pressure ulcers, vascular ulcers (arterial and venous hypertension), and neuropathic ulcers. Treatment of these ulcers involves recognizing the four stages of healing: coagulation, inflammation, proliferation, and maturation. Chronic wounds are frequently stalled in the inflammatory stage. Moving past the inflammation stage requires considering the bacterial burden, necrotic tissue, and moisture balance of the wound being treated. Bacterial overgrowth or infection needs to be treated with topical or systemic agents. In most cases, necrotic tissue needs to be debrided and moisture balance needs to be addressed by wetting dry tissue and drying wet tissue. Special dressings have been developed to accomplish these tasks. They include films, hydrocolloids, hydrogel dressings, foams, hydrofibers, composite and alginate dressings

Chronic Dermal Ulcer Healing Enhanced with Monophasic Pulsed Electrical Stimulation

The purposes of this randomized, double-blind, multicenter study were to compare healing of chronic dermal ulcers treated with pulsed electrical stimulation with healing of similar wounds treated with sham electrical stimulation and to evaluate patient tolerance to the therapeutic protocol. Forty-seven patients, aged 29 to 91 years, with 50 stage II, III, and IV ulcers were randomly assigned to either a treatment group (n=26) or a control (sham treatment) group (n=24). Treated wounds received 30 minutes of pulsed cathodal electrical stimulation twice daily at a pulse frequency of 128 pulses per second (pps) and a peak amplitude of 29.2 mA if the wound contained necrotic tissue or any drainage that was not serosanguinous. A saline-moistened nontreatment electrode was applied 30.5 cm (12 in) cephalad from the wound. This protocol was continued for 3 days after the wound was debrided or exhibited serosanguinous drainage. Thereafter, the polarity of the treatment electrode on the wound was changed every 3 days until the wound progressed to a stage II classification. The pulse frequency was then reduced to 64 pps, and the treatment electrode polarity was changed daily until the wound was healed. Patients in the control group were treated with the same protocol, except they received sham electrical stimulation. After 4 weeks, wounds in the treatment and control groups were 44% and 67% of their initial size, respectively. The healing rates per week for the treatment and control groups were 14% and 8.25%, respectively. The results of this study indicate that pulsed electrical stimulation has a beneficial effect on healing stage II, III, and IV chronic dermal ulcers