Updated Scar Management Practical Guidelines: Non-invasive and invasive measures

Summary Hypertrophic scars and keloids can be aesthetically displeasing and lead to severe psychosocial impairment. Many invasive and non-invasive options are available for the plastic (and any other) surgeon both to prevent and to treat abnormal scar formation. Recently, an updated set of practical evidence-based guidelines for the management of hypertrophic scars and keloids was developed by an international group of 24 experts from a wide range of specialities. An initial set of strategies to minimize the risk of scar formation is applicable to all types of scars and is indicated before, during and immediately after surgery. In addition to optimal surgical management, this includes measures to reduce skin tension, and to provide taping, hydration and ultraviolet (UV) protection of the early scar tissue. Silicone sheeting or gel is universally considered as the first-line prophylactic and treatment option for hypertrophic scars and keloids. The efficacy and safety of this gold-standard, non-invasive therapy has been demonstrated in many clinical studies. Other (more specialized) scar treatment options are available for high-risk patients and/or scars. Pressure garments may be indicated for more widespread scarring, especially after burns. At a later stage, more invasive or surgical procedures may be necessary for the correction of permanent unaesthetic scars and can be combined with adjuvant measures to achieve optimal outcomes. The choice of scar management measures for a particular patient should be based on the newly updated evidence-based recommendations taking individual patient and wound characteristics into consideration

Update on the role of antiseptics in the management of chronic wounds with critical colonisation and/or biofilm

Biofilms play a major role in delaying chronic wounds from healing. A wound infiltrated with biofilm, or “critically colonised” wound, may become clinically infected if the number of microbes exceeds a critical level. Chronic wound biofilms represent a significant treatment challenge by demonstrating recalcitrance towards antimicrobial agents. However, a “window of opportunity” may exist after wound debridement when biofilms are more susceptible to topical antiseptics. Here, we discuss the role of antiseptics in the management of chronic wounds and biofilm, focusing on povidone-iodine (PVP-I) in comparison with two commonly used antiseptics: polyhexanide (PHMB) and silver. This article is based on the literature reviewed during a focus group meeting on antiseptics in wound care and biofilm management, and on a PubMed search conducted in March 2020. Compared with PHMB and silver, PVP-I has a broader spectrum of antimicrobial activity, potent antibiofilm efficacy, no acquired bacterial resistance or cross-resistance, low cytotoxicity, good tolerability, and an ability to promote wound healing. PVP-I represents a viable therapeutic option in wound care and biofilm management, with the potential to treat biofilm-infiltrated, critically colonised wounds. We propose a practical algorithm to guide the management of chronic, non-healing wounds due to critical colonisation or biofilm, using PVP-I.info:eu-repo/semantics/publishedVersio

Comparaison de la cicatrisation des escarres de décubitus dans des populations gériatriques et neurologiques traitées localement par un pansement hydrocolloïde

PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Conséquences cutanées des chutes chez la personne âgée institutionnalisée

Les chutes chez la personne âgée représentent un problème de santé publique et une cause importante de morbi-mortalité. Les conséquences cutanées de ces chutes sont certes fréquentes mais moins graves. Il existe peu d études épidémiologiques sur ce sujet. L objectif de cette étude est de répertoriés et décrire les lésions cutanées secondaires aux chutes sur une population hospitalisée à l Hôpital Charles Foix, d Ivry-sur-Seine qui accueille à l AP-HIP plus de 900 personnes âgées. Nous avons trouvé que sur la totalité des chutes, 30 % donne lieu à des lésions cutanées. Le plus souvent les lésions cutanées se présente comme des lésions multiples, localisé à la tête. Les lésions des plus fréquentes sont les hématomes Le risque de lésion cutanée augmente avec l âge. La formation des équipes et des médecins représente un enjeu important pour améliorer leur prise en charge.PARIS13-BU Serge Lebovici (930082101) / SudocSudocFranceF

IMPACT D'UN GUIDE PRATIQUE SUR LES CONNAISSANCES DES SOIGNANTS(DANS UN HOPITAL GENERAL) SUR LE DIAGNOSTIC ET LA PREVENTION DES ESCARRES. ENQUETE DE PREVALENCE ET AUDIT DES CONNAISSANCES A 3 ANS D'INTERVALLE

PARIS12-CRETEIL BU Médecine (940282101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Contact allergy in chronic leg ulcers: results of a multicentre study carried out in 423 patients and proposal for an updated series of patch tests

International audienc

Management of scars: Updated practical guidelines and use of silicones

Hypertrophic scars and keloids resulting from surgery, burns, trauma and infection can be associated with substantial physical and psychological distress. Various non-invasive and invasive options are currently available for the prevention and treatment of these scars. Recently, an international multidisciplinary group of 24 experts on scar management (dermatologists; plastic and reconstructive surgeons; general surgeons; physical medicine, rehabilitation and burns specialists; psychosocial and behavioural researchers; epidemiologists; beauticians) convened to update a set of practical guidelines for the prevention and treatment of hypertrophic and keloid scars on the basis of the latest published clinical evidence on existing scar management options. Silicone-based products such as sheets and gels are recommended as the gold standard, firstline, non-invasive option for both the prevention and treatment of scars. Other general scar preventative measures include avoiding sun exposure, compression therapy, taping and the use of moisturisers. Invasive treatment options include intralesional injections of corticosteroids and/or 5-fluorouracil, cryotherapy, radiotherapy, laser therapy and surgical excision. All of these options may be used alone or as part of combination therapy. Of utmost importance is the regular re-evaluation of patients every four to eight weeks to evaluate whether additional treatment is warranted. The amount of scar management measures that are applied to each wound depends on the patient’s risk of developing a scar and their level of concern about the scar’s appearance. The practical advice presented in the current guidelines should be combined with clinical judgement when deciding on the most appropriate scar management measures for an individual patient.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Skin necrosis

In recent years, wound care has gained increasing recognition as a distinct medical specialty. An understanding of the complex mechanisms involved in wound healing facilitates efficient assessment and treatment of patients with wounds, and skin necrosis can be considered the starting point in the entire healing process. This book is the first to discuss skin necrosis as a symptom related to a broad range of pathologies. Richly illustrated, it primarily provides therapeutic strategies and treatment algorithms for different clinical contexts. All chapters were written by renowned specialists in their respected fields and include detailed sample cases and essential take-home messages. In light of the highly interdisciplinary nature of wound management, Skin Necrosis offers an invaluable resource for wound care practitioners and health care professionals across the fields of surgery, dermatology, internal medicine, and nursing.SCOPUS: bk.binfo:eu-repo/semantics/publishe

3.5 billion hours of nurse time released by 2030 ::potential efficiency gains from shared care and longwear advanced foam dressings

The prevalence of chronic wounds is increasing, adding to the burden on the already overstretched nursing population. There is a clear need for new ways of working to mitigate the issues faced by nurses. The benefits of shared care and greater patient involvement are well documented and can be applied to chronic wound care for clinically appropriate patients. Long-wear advanced foam dressings can support a shared-care approach by allowing nurses and patients to practice undisturbed healing. This article introduces a mathematical model that proposes by using long-wear advanced foam dressings within a shared-care approach some 3.5 billion nursing hours globally could be saved by 2030. Releasing this time has the potential to improve patient quality of life and allow nurses to spend more time where it is most needed, improving quality of care and outcomes