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Principles of wound care
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
In this section, you focus on care of the wound itself, using a concept called wound-bed preparation (WBP). The focus of WBP denotes the importance of removing non-viable tissue (necrosis and slough) through cleansing/debridement, moisture balance, control of oedema and decreased bacterial burden (Ousey and Cook 2012) to promote healing.
Wound care
Published in Cooper Jo, Burnard Philip, Stepping into Palliative Care 2, 2017
More recently the concept of wound bed preparation37 has become associated with the assessment of devitalised tissues within wounds, and the TIME framework, found to be particularly helpful by practitioners for the specific/focused assessment of chronic skin lesions such as fungating wounds, was developed in conjunction with this concept.38
Local treatment of venous ulcers
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
William A. Marston, Thomas F. O’Donnell
The SVS/AVF guidelines, as well as most other recent guidelines on the care of venous ulcers, have defined the following key elements of wound bed preparation: (1) debridement of the non-vital tissue from the wound, which provides a nidus for bacterial infection; (2) cleansing the wound; (3) controlling bacterial colonization with wound care, while treating true wound infection aggressively with antibiotics; (4) providing optimal moisture and temperature balance, usually by the wound dressing; (5) optimizing general nutrition; and (6) employing mechanical measures that favorably alter local hemodynamics (discussed in other chapters).5
Reconstruction of necrotizing soft tissue infection in the auricle and temporal region: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Junpei Saito, Shoichi Ishikawa, Shigeru Ichioka
An emergency debridement was performed. The necrotic skin was excised, and additional skin incisions were made so that the necrosis of the subcutaneous tissues could be confirmed. The necrotic subcutaneous tissue and temporal fascia were excised one layer at a time. Visually, the temporalis muscle did not appear to have obvious necrosis. Furthermore, the upper portion of the auricle was detached by debridement, and a color change occurred due to insufficient blood flow. To salvage the auricle, the temporalis muscle flap was elevated above the periosteum and inverted to cover the auricle (Figure 2). A second debridement was performed 12 days later, and the necrotic skin and periosteum were excised. Negative-pressure wound therapy (NPWT) was started at the end of surgery (Figure 3). A third debridement was performed 26 days after. Because of the exposed temporal bone, the extracranial plate was shaved until petechial hemorrhage could occur, and the artificial dermis was applied (Figure 4). NPWT was used for 9 days to fix the artificial dermis. When purulent exudation and edematous granulation increased, local treatment consisted of washing and dressing to achieve wound bed preparation and good granulation of the ulcer surface. The artificial dermis was successfully applied, and the skull was no longer exposed due to granulation.
The surgical strategy of Purpura fulminans triggered by pyothorax associated with lung cancer
Published in Case Reports in Plastic Surgery and Hand Surgery, 2020
Yoshitaka Matsuura, Katsuya Kawai
First, we decided to save as much of the left leg as possible, as the necrosis did not involve the heel (Figure 2(A)). The left foot was therefore amputated at the level of the metatarsal bone, and all necrotic tissue was excised (Figure 2(B,E)). The exposed bone associated with the stump presented a problem in connection with the next surgery, skin graft. As a result, negative pressure wound therapy (NPWT) was applied to the wound exposed bone in order to speed up the healing process and cover the bone with granulation tissue. The effectiveness of this therapy for wounds with exposed bone in the lower extremities has been previously described [3]. The device we used was an ACTIV.A.C® (K.C.I, San Antonio, USA), and the pressure was adjusted 50 mmHg. After three weeks, the wound improved and exposed bone was now almost completely covered with granulation tissue. The wound bed preparation before performing skin grafting was thus considered to be sufficient (Figure 2(C)). Finally, a partial-thickness skin graft (20/1000 inch) was used to cover the wound (Figure 2(D)). All of the engrafted skin survived.
Negative pressure wound therapy and skin grafting for necrotizing fasciitis in a patient with rheumatoid arthritis treated with abatacept: A case report
Published in Modern Rheumatology, 2018
Takeshi Mochizuki, Katsunori Ikari, Ryo Hiroshima, Hiromitsu Takaoka, Kosei Kawakami, Naoko Koenuma, Mina Ishibashi, Shigeki Momohara
In our case, as soon as NF was diagnosed, emergency and repeat debridement were performed. After debridement, wound management is important because many patients with NF have underlying diseases such as diabetes, peripheral vascular disease, or systemic immunosuppression [13]. Our patient had systemic immunosuppression owing to RA and use of biological DMARDs. If the open wound after debridement is large, skin grafting must be considered. For infection control and granulomatous promotion of the open wound, we used NPWT. NPWT is used to promote the formation of granulation tissue, which reduces the volume of the lost tissue, helps to shrink the edges of the wound, and has been reported to reduce the area of the wound [14]. In our case, the open wound was filled with granulation, which improved the condition of the wound for skin grafting. For skin grafting, it is important for the skin graft portion to be in close contact with the mother floor. We also continued NPWT after skin grafting, which we believe helped to repair the wound and prevent infection. In our case, the skin graft site did not become infected and the mother floor was repaired earlier. In a previous randomized controlled trial, NPWT was shown to have advantages regarding time to complete healing and wound bed preparation time compared with conventional wound care [15]. Therefore, we think that the indication of NPWT is wide and deep skin damage and infection, additionally NPWT appeared to be useful before and after skin grafting as our case.