Wound digest


leg ulceration and that evaluated at least one systemic antibiotic, topical antibiotic or topical antiseptic. In terms of data collection, a standardised data extraction form was used to collate information on patient characteristics, interventions and outcomes.


n A total of 45 RCTs were included in the review, which covered 4486 individuals. Ulcer infection status at baseline and at follow-up was found to vary across the RCTs chosen, while few of these trials proved to contain a reliable estimate relating to healing times.


n During their review, the authors found some evidence to suggest cadexomer iodine is effective in terms of topical preparations, while the literature does not support the routine use of honey- or silver-based products. Meanwhile, they conclude that further research is warranted to ascertain the effectiveness of particular antibacterial agents. The assertion is that clinicians must be mindful of increased concerns about bacterial resistance when using antibacterial treatments.


O’Meara S, Al-Kurdi D, Ologun Y et al (2014) Antibiotics and antiseptics for venous leg ulcers (Review). Cochrane Database Syst Rev 10(1): CD003557


4 Analysis of MRI for acute Charcot foot diagnosis Readability


Relevance to daily practice Novelty factor


a a a a a a a a a a a a


n This retrospective, observational, cohort study over a 12-year period, reviewed the management of all acute Charcot foot (ACF) cases, in one outpatient clinic, diagnosed by magnetic resonance imaging (MRI).


n Treatment included complete offloading and immobilisation of the affected foot, and, within 3 days, a removable total contact cast (TCC) and crutches were provided.


n From the medical charts of 59 patients with a total of 71 ACF cases, it was deduced that ACF healing is more efficient when it is diagnosed at stage 0 rather than stage 1 (P=0.0012).


n Patients that reported foot pain were significantly more able to recall when a trauma had occurred than those that did not have foot pain. However, those with foot pain did not attend the clinic any earlier.


n In total, 70% of those diagnosed at ACF stage 0, and 32% of those diagnosed at ACF stage 1 healed without deformity (P=0.002).


n The authors noted that MRI was essential for ACF diagnosis at stage 0 as unremarkable X-ray results often led to misdiagnosis.


n No amputations or further surgery had occurred 4 years after healing.


n The authors note one limitation of the study as the fact there was no control cohort where ACF was managed on the basis of X-ray.


Chantelau EA, Richter A (2013) The acute diabetic Charcot foot managed on the basis of magnetic resonance imaging – a review of 71 cases. Swiss Med Wkly 143: w13831


5


Optimal rocker shoe design for individuals with no diabetic foot


Readability


Relevance to daily practice Novelty factor


a a a a a a a a a


n This is the first study to attempt to find the optimum rocker shoe design for individuals with low-risk diabetes. Twelve shoe designs in a variety of values for the apex angle, apex position and rocker angle (plus a flexible control) were tested.


n In total, 24 people with low-risk diabetes with no previous foot complications, and 24 healthy participants walked a 20 m walkway at 1 m/s ± 10% distance in each shoe design (25–35 continuous steps per shoe).


n Peak plantar pressure was measured for the 1st metatarsophalangael (MTP) joint, 2nd–4th metarsal head (MTH), hallux, 5th MTH and heel.


n When the apex angle was incrementally increased from 70º to 100º, the biggest reduction in pressure relative to the control shoe was observed in the 2nd–4th MTH regions (39%).


n There was no clear trend in foot pressures across the foot when varying the apex position from 50% to 70%.


n When the rocker angle was increased from 10º to 30º, there was a decrease in peak pressure under the 5th MTH.


n The results suggest that for the optimum shoe design a 95º apex angle, an apex position of 60% of shoe length and a 20º rocker angle should be considered. Chapman JD, Preece S, Braunstein B et al (2013) Effect of rocker shoe design features on forefoot plantar pressures in people with and without diabetes. Clin Biomech 28(6): 679–85


6


Cost of care using prophylactic negative pressure wound vacuum on closed laparotomy incisions


Readability


Relevance to daily practice Novelty factor


a a a a a a a a a


n The authors sought to determine the decrease in wound complication rate needed to justify prophylactic negative pressure wound vacuum therapy (NPWT) compared to routine incision care (RC), in terms of cost savings, following laparotomy for gynaecologic malignancy.


n A decision model was made from a third-party payer perspective to compare NPWT and RC; the primary model outcome was average incision care cost using each strategy. Clinical parameter estimates (wound complication rates, re-hospitalisation, antibiotic use, re-operation and home health care) were taken from a published cohort of 431 women who underwent laparotomy for endometrial cancer between 2002–2007.


n Wound complication rate was 31%. The overall cost saving was US$104 for NPWT with the lowest cost of this therapy US$200.


n Prophylactic NPWT has the potential to be a cost saving treatment option if wound complication rate is reduced by a third or more.


Lewis LS, Convery PA, Bolac CS et al (2014) Cost of care using prophylactic negative pressure wound vacuum on closed laparotomy incisions. Gynecol Oncol [epub ahead of print]


Wounds International Vol 5 | Issue 1 | ©Wounds International 2014 | www.woundsinternational.com 29


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