Wound digest Wound digest
This digest summarises recent key papers published in the areas of pressure ulcers, skin integrity, venous leg ulcers and diabetic foot ulcers.
SELECTED PAPERS OF INTEREST 1. Using temperature of pressure-related intact discoloured areas of skin to detect deep tissue injury 2. Relative cost-effectiveness of a skin protectant in managing venous leg ulcers in the UK
To compile the digest, a Medline search was performed for the three months ending in August 2012 using the search terms ‘pressure ulcers’, ‘skin integrity,’ ‘leg ulcers’ and ‘diabetic foot ulcers’. Papers have been chosen on the basis of their potential interest to practitioners involved in day-to-day wound care. The papers were rated according to readability, applicability to daily practice and novelty factor.
Pressure ulcers 1
Using temperature of pressure-related intact discoloured areas of skin to
detect deep tissue injury: An observational, retrospective, correlational study
Readability Relevance to daily practice Novelty factor
n This study was conducted in order to investigate the effect of temperature difference between a pressure-related intact discoloured area of skin (PRIDAS) and its adjacent intact skin, and the subsequent development of skin necrosis. A total of 85 patients were studied.
n PRIDAS are most commonly described as an area of non-blanching erythema (stage I pressure ulcer) or deep tissue injury (DTI), however, the validity of these definitions has not been tested.
n Data from all acute care hospital patients with an observed PRIDAS who received a skin integrity consult, including a skin temperature measurement of a PRIDAS site, were abstracted to examine whether PRIDAS temperature correlated with the development of skin necrosis after between seven and 14 days.
n Aside from this, the study also looked at the effect of additional patient variables on the progression or resolution of a PRIDAS. Skin temperatures were measured using a commercial, hand-held, infrared
62 Wounds International Vol 3 | Issue 3 | ©Wounds International 2012
thermography camera, and the presence or absence of capillary refill was documented.
n The difference between PRIDAS temperature and adjacent skin was found to range from -3.2o to +3.0o
C C and of the 55 PRIDAS with a lower
temperature at baseline than the adjacent skin, 29 progressed to necrosis, compared with one-in-30 PRIDAS with a higher temperature than adjacent skin. After adjusting for patient age, skin colour, and PRIDAS site, the cool PRIDAS were 31.8 times more likely to progress to necrosis than the warm PRIDAS.
n Incidentally, when reassessing study patients on days two through six, before performing the seven to 14-day study follow-up, the PRIDAS often disappeared before the appearance of the DTI. This underscores the importance of assessing PRIDAS when first discovered and the need for research in this area.
n The conclusion of this study suggests that skin temperature measurement of PRIDAS can assist in the detection of underlying skin necrosis. Cool PRIDAS are 31.8 times more likely to progress to necrosis than warm PRIDAS.
n The authors state that the National Pressure Ulcer Advisory Panel (NPUAP) definition of a stage I pressure ulcer used at present should be amended to reflect the strong relationship to DTI development.
Farid KJ, Winkleman C, Rizkala A, Jones K. Using temperature of pressure-related intact discoloured areas of skin to detect deep tissue injury: an observational, retrospective, correlational study. Ostomy Wound Manage 2012; Aug 58(8): 20–31
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