Technology update The role of ALLEVYNTM


Ag in the management of hard-to-heal wounds


factor to the failure of some acute surgical wounds to close. The presence of biofilms is also implicated in some chronic wounds becoming hard to heal[24]


sexuality[31] . Biofilms are different


from normal bacterial colonies in that they are usually composed of mixed microbial species in mutually supportive complex communities attached to the surfaces of a wound and distinct from their planktonic counterparts[24] In addition, studies have shown that


.


elevated levels of pro-inflammatory cytokines found in some hard-to-heal wounds can lead to the degradation of newly formed extracellular matrix (ECM) and other proteins, such as growth factors and receptors[25,26]


. As a result,


the wound becomes stuck in the inflammatory stage, and fails to progress to the proliferative phase[27]


. Some studies assume that these


changes are due to a defect or disorder in the host’s ability to regulate the inflammatory processes. Other studies have shown that biofilms can ‘hijack’ the host response to infection by producing a high level of virulence factors that can either dampen or re-orient the innate and adaptive immune response that usually maintains the inflammatory process[28]


.


Other contributors to delayed closure include patient-related elements such as diabetes, obesity, hyperglycaemia, tissue hypoxia, old age and restrictions in mobility, all of which need to be addressed as part of a comprehensive assessment, along with other wound-related factors such as wound size and depth, anatomical location, duration and wound-bed condition[6]


.


IMPACT OF WELLBEING ON WOUND CLOSURE In addition to the clinical challenges, there is increasing evidence to support a relationship between psychological and socioeconomic factors (such as a patient living alone or with poor nutritional status) and delayed wound closure[28]


. Living with a wound is associated


with increased anxiety and poor quality of life[3,29]


. To capture patient experiences, a large-scale


survey was conducted in 15 different countries with over 2,018 patients and reported in a variety of studies [30,31,32]


. Data from focus


group work was consistent in showing that pain is one of the symptoms that patients find particularly distressing. Pain can impact on a patient’s ability to cope, along with feelings of loss of control, ‘uncleanliness’ and a reduced sense of self-identity, which may also affect


CLINICAL APPROACHES FOR HARD-TO-HEAL WOUNDS Management of wounds should focus on identifying problems early and using appropriate strategies and interventions to facilitate closure. According to several reports[34,18]


hard-to-heal wounds are often


treated using one strategy at a time. Due to an increase in antibiotic-resistant strains of


www.woundsinternational.com 30


. In addition, the wound may affect


the patient’s ability to perform everyday activities, which can lead to social withdrawal and loss of financial independence[31]


.


Many patients who live with a wound over a long period of time indicate that symptom management is very important. Symptoms such as pain, odour and exudate can affect the way patients conduct their lives and they may worry that the wound will deteriorate, never heal or become infected. While patients report that their priority is for the wound to close, the ability to improve patient wellbeing appears to rely on appropriate symptom management, allowing them to get the most out of their daily living. For many patients, managing the symptom most important to them, rather than closure, can be the next step in care management[33]


. The emphasis is on the need to address


patient concerns through a holistic approach. Listening to patients can help clinicians gain their confidence and trust, leading to a partnership in which, for example, the patient feels able to discuss concerns about medication and clinicians can offer evidence- based advice to the patient on topics such as wound dressings and compression bandaging. A treatment plan can then be mutually agreed[4]


. The quality of the relationship


between the patient and the clinician can impact positively on treatment outcomes, improve quality of life and help to reduce costs by improving concordance with treatment[1,4,16]


In addition, access to care and referral to clinicians with the appropriate knowledge and skills is vital for an early diagnosis and ensuring that appropriate treatment strategies are used to either achieve closure or manage the symptoms effectively. The importance of educating staff so that they know how to develop wound-care protocols and access resources cannot be underestimated. Such factors will vary in different parts of the world according to national and local standards and priorities for healthcare delivery[6]


. References


6. European Wound Management Association (EWMA). Position Document. Hard to heal wounds: a holistic approach. MEP Ltd, London 2008.


7. Brem H, Kirsner RS, Falanga V. Protocol for the successful treatment of venous ulcers. Am J Surg 2004; 188(1A Suppl): 1–8.


8. International guidelines. Pressure ulcer prevention: prevalence and incidence in context. A consensus document. London: MEP Ltd, 2009.


9. Rabe E, Pannier F. Societal costs of chronic venous disease in CEAP C4, C5, C6 disease. Phlebology 2010; 25(Suppl 1): 64–7.


10. Madsen SM, Westh H, Danielsen L, Rosdahl VT. Bacterial colonization and healing of venous leg ulcers. APMIS 1996; 104(12): 895–9.


.


11. Vowden P, Romanelli M, Peter PR, et al. The effect of amelogenins (Xelma™) on hard– to–heal venous leg ulcers. Wound Rep Regen 2006; 14(3): 240–6.


12. Margolis DJ, Allen–Taylor L, Hoffstad O, Berlin JA. The accuracy of venous leg ulcer prognostic models in a wound care system. Wound Repair Regen 2004; 12(2): 163–8.


13. Vin F, Teot L, Meaume S. The healing properties of Promogran in venous leg ulcers. J Wound Care 2002; 11(9): 335–41.


14. Mostow EN, Haraway GD, Dalsing M, et al. Effectiveness of an extracellular matrix graft (OASIS Wound Matrix) in the treatment of chronic leg ulcers: a randomized clinical trial. J Vasc Surg 2005; 41(5): 837–43.


15. Robson MC, Phillips TJ, Falanga V, et al. Randomized trial of topically applied repifermin (recombinant human keratinocyte growth factor–2) to accelerate wound healing in venous ulcers. Wound Repair Regen 2001; 9(5): 347–52.


Technology and product reviews


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53