Nurses' and surgeons' views and experiences of surgical wounds healing by secondary intention : a qualitative study

AIMS AND OBJECTIVES: To explore surgeons' and nurses' perspectives of managing surgical wounds healing by secondary intention. BACKGROUND: Every year, more than 10 million surgical operations are performed in the NHS in the UK. Most surgical wounds heal by primary intention, where the edges of the wound are brought together with staples, sutures, adhesive glue or clips. Sometimes wounds are deliberately left open to heal, from the base up, known as 'healing by secondary intention'. These wounds are often slow to heal, prone to infection, and complex to manage. DESIGN: A qualitative, descriptive approach, using semi-structured interviews. METHODS: Interviews with five (general, vascular and plastic) surgeons and 7 nurses (3 tissue viability nurses, 2 district and 1 community nurse, and 1 hospital nurse) working in hospital and community care settings in two locations in the north of England. Data analysis followed the recommended sequential steps of 'Framework' approach. Consolidated criteria for reporting qualitative research guided the study report. RESULTS: Participants reported that the main types of wounds healing by secondary intention that they manage are extensive abdominal cavity wounds; open wounds relating to treatment for pilonidal sinus; large open wounds on the feet of patients with diabetes; and axilla and groin wounds, associated with removal of lymph nodes for cancer. Infection and prolonged time to healing were the main challenges. Negative pressure wound therapy was the most favoured treatment option. CONCLUSIONS: Negative pressure wound therapy was advocated by professionals despite a lack of research evidence indicating clinical or cost-effectiveness. Our findings underscore the need for rigorous evaluation of negative pressure wound therapy, and other wound care treatments, through studies that include economic evaluation. RELEVANCE FOR CLINICAL PRACTICE: Clinical decision making in wound care could be optimised through further robust studies to inform practitioners about the cost-effectiveness of available treatments

Sensitivity to BST-2 restriction correlates with Orthobunyavirus host range

Orthobunyaviruses include several recently emerging viruses of significant medical and veterinary importance. There is currently very limited understanding on what determines the host species range of these pathogens. In this study we discovered that BST-2/tetherin restricts orthobunyavirus replication in a host-specific manner. We show that viruses with human tropism (Oropouche virus and La Crosse virus) are restricted by sheep BST-2 but not by the human orthologue, while viruses with ruminant tropism (Schmallenberg virus and others) are restricted by human BST-2 but not by the sheep orthologue. We also show that BST-2 blocks orthobunyaviruses replication by reducing the amount of envelope glycoprotein into viral particles egressing from infected cells. This is the first study identifying a restriction factor that correlates with species susceptibility to orthobunyavirus infection. This work provides insight to help us dissect the adaptive changes that bunyaviruses require to cross the species barrier and emerge into new species

Wound moisture can be measured without disturbing the dressing

Aim: To demonstrate that a small, sterile sensor* placed on the wound surface during dressing application can indicate wound moisture status without disturbing the dressing. Methods: A sterile moisture sensor was approved for clinical trial in Venous Leg Ulcer Patients. Patients were recruited to the trial at the beginning of their referral for treatment. Patients recruited to the trial were treated as per best practice by compression therapy. The trial purpose was to examine moisture status recorded by the sensor and compare this with observation and dressing change evidence. The sensor was placed over the wound and then secured in place with a compression bandaging system. Moisture was recorded daily by a research nurse using a hand-held meter. Dressings were changed on a weekly basis and photographs and clinical observation of the wounds were made. Each subject was asked at the end of the study to complete a questionnaire regarding the experience

Monitoring moisture without disturbing the wound dressing

The cost of chronic wounds is estimated in the UK to be £2.6 billion per annum, with 200,000 patients at any one time having a chronic wound (Posnett and Franks, 2005). The nursing time involved in dressing changes takes up a considerable amount of this cost. A major advance would be to monitor the moisture level at the wound bed while leaving the dressing undisturbed, with changes taking place only when necessary. An initial study of 15 patients with venous leg ulcers demonstrated the effectiveness of a new sensor to monitor moisture levels at the wound bed

Executive Leadership Panel Discussion: Moderated by Marc Bernier

The Executive Leadership Panel, Bio and Photo Links: Richard H. Heist, Chief Academic Officer, ERAUNancee I. Bailey, Vice President for Student Affairs, ERAUJohn R. Watret, Chancellor of Worldwide, ERAUBecky L. Vasquez, Chief Technology Officer, ERAU Moderated by Marc Bernie