News Wound digest Wound digest This digest summarises some of the key papers published on issues related to wound management SELECTED PAPERS OF INTEREST


1. Effectiveness of percutaneous tenotomy for diabetic toe ulcers


2. Oral treatment of pressure ulcers with polaprezinc (zinc L-carnosine complex): 8-week open-label trial


3. Repositioning for pressure ulcer prevention in adults


4. Examining factors that influence the adoption of health- promoting behaviours among people with venous disease


5. A prospective, randomised comparative study of weekly versus biweekly application of dehydrated human amnion/ chorion membrane allograft in the management of diabetic foot ulcers


6. Comparative effectiveness of advanced wound dressings for patients with chronic venous leg ulcers: a systematic review


n Patients (n=14; nine men; 68.4 ± 11.8 years of age) with stage II–IV pressure ulcers (II, n=1; III, n=9; IV, n=4) of ≥8 weeks’ duration were recruited and received 150 mg/day of oral polaprezinc (116 mg L-carnosine; 34 mg zinc) for a maximum of 8 weeks; pressure ulcer severity was measured weekly using the Pressure Ulcer Scale for Healing (PUSH) score and blood biochemistry was monitored.


n Eleven patients healed within 8 weeks; none withdrew. n From baseline to 8 weeks, the PUSH score improved significantly (8.1 [95 % confidence internal [CI]: 6.0–10.3] to –1.4 [95% CI: –4.0–1.1; P<0.001]); the difference from baseline became significant after 1 week (P<0.05) with a mean weekly improvement in PUSH score of 2.0.


n During the course of treatment, serum zinc levels increased significantly (P<0.001), while serum copper levels (P=0.001) and copper : zinc ratios (P<0.001) decreased significantly.


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Effectiveness of percutaneous tenotomy for diabetic toe ulcers


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n The authors evaluated the effectiveness of percutaneous flexor and/or extensor tenotomy procedures for the treatment of diabetic, neuropathic toe ulcers.


n The medical files of 83 individuals were reviewed and, in total, percutaneous tenotomy procedures were carried out for 103 tip-of-toe ulcers; 26 cock-up/dorsal ulcers; 21 kissing ulcers; and 10 plantar metatarsal ulcers.


n A successful response to the procedure was a healing response at week 1 and wound closure at week 4 post- procedure.


n Percutaneous tenotomy procedures were successful for the treatment of tip-of-toe ulcers, kissing ulcers, and cock-up ulcers (P<0.01). However, they were not successful for the treatment of plantar metatarsal ulcers.


Tamir E, Vigler M, Avisar E, Finestone AS (2014) Percutaneous tenotomy for the treatment of diabetic toe ulcers. Foot Ankle Int 35(1): 38–43


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Oral treatment of pressure ulcers with polaprezinc (zinc L-carnosine complex):


8-week open-label trial Readability


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n The authors aimed to evaluate the efficacy and safety of polaprezinc (oral zinc L-carnosine complex; an agent commonly prescribed for gastric ulcers in Japan) over 8 weeks’ treatment for chronic pressure ulcers.


n Pre-existing copper deficiency deteriorated in one participant. n Data from this small cohort suggest that 8 weeks of oral polaprezinc may be effective and well-tolerated in the treatment of pressure ulcers.


Sakae K, Yanagisawa H (2014) Oral treatment of pressure ulcers with polaprezinc (zinc L-carnosine complex): 8-week open-label trial. Biol Trace Elem Res: 3 Apr [Epub ahead of print]


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Repositioning for pressure ulcer prevention in adults


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n The authors undertook a literature review to assess the effects of repositioning on the prevention of pressure ulcers (PUs) in adults – regardless of risk or inpatient setting – to ascertain the most effective repositioning schedules for adult PU prevention, and also to ascertain the cost associated with implementing different repositioning regimens, compared with alternate schedules or standard practice.


n Randomised controlled trials (RCTs) that assessed the effects of any repositioning schedule or different patient positions and measured PU incidence in adults in any setting were collected from electronic databases and the reference sections of included studies.


n Three RCTs and one economic study were included in the review (representing a collective total of 502 participants).


n Two trials compared the 30º and 90º tilt positions using similar repositioning frequencies, the third RCT compared alternative repositioning frequencies. All three trials were underpowered and at high risk of bias.


n The risk ratio (RR) for PUs (any category) with 2-hourly repositioning compared with 3-hourly repositioning on a standard mattress was 0.90 (95% CI: 0.69–1.16), and was not significantly different for 4- and 6-hourly repositioning on viscoelastic foam mattresses (RR 0.73; 95% CI: 0.53–1.02). n A cost-effectiveness analysis of nursing time revealed that


Wounds International Vol 5 | Issue 2 | ©Wounds International 2014 | www.woundsinternational.com 31


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