New and Updated Cochrane Systematic Reviews

Objective: Reconstruction of large abdominal wall defects is a challenging procedure, often contraindicated in critically ill patients, with high incidences of complications. We present a case of a patient with a large abdominal wall defect who had reconstruction with MatriDerm® (an engineered dermal template) and split thickness skin grafting (SSG) as an alternative to reconstruction with myoor fascio-cutaneous flaps. Successful wound closure was achieved with a single technique, while providing a robust reconstruction and an interface between skin and underlying viscera, should further surgery be necessary. [PUBLICATION] 14 references Source: BNI Full text: Available Mark Allen Group at Journal of Wound Care 4.Title: A novel approach to the treatment of diabetic foot abscesses a case series Citation: Journal of Wound Care, Aug 2014, vol. 23, no. 8, p. 394-399, 0969-0700 (August 2014) Author(s): Cahn, A., Kleinman, Y. Abstract: Diabetic foot abscesses are an occasional complication of diabetic foot infections usually involving osteomyelitis and significant soft tissue injury. The standard of care for diabetic foot abscesses is the performance of immediate surgical drainage and debridement. However, this therapeutic mode involves more often than not, some extent of minor amputation and bony loss. With the advent of new therapeutic techniques it may be possible to treat diabetic foot abscesses conservatively. Objective: To explore adjunct therapies in the treatment of diabetic foot abscesses in order to avoid extensive surgery, amputation and tissue loss whilst maintaining limb integrity. Method and Results: Between January 2011 and June 2012, six patients with a diabetic foot abscess and osteomyelitis presented at our diabetic foot clinic. They were treated with topical oxygen and the abscesses were drained using PolyMem® Wic® Silver Rope (PWSR). All patients experienced full recovery and remained disease free during a follow up period of 4-21 months. Conclusion: Amputation and the removal of infected bone had once been considered the sole treatment for diabetic foot osteomyelitis. Multiple case series and accumulation of clinical experience has shown otherwise, and nowadays medical management of osteomyelitis is the preferred treatment in select patients. In our study, we present a case series of patients suffering from diabetic foot abscesses treated non-surgically. Hopefully this series will lay the foundation for further data demonstrating the feasibility of a conservative approach for diabetic foot abscesses, which may overcome the infection without requiring amputation. [PUBLICATION] 31 references Source: BNI Full text: Available Mark Allen Group at Journal of Wound Care 5.Title: A prospective, randomized, controlled, clinical study to evaluate the efficacy of high-frequency ultrasound in the treatment of Stage II and Stage III pressure ulcers in geriatric patients Citation: Ostomy Wound Management, Aug 2014, vol. 60, no. 8, p. 16-28, 0889-5899 (August 2014) Author(s): Polak, Anna, Franek, Andrzej, Blaszczak, Edward, Nawrat-Szoltysik, Agnieszka, Taradaj, Jakub, Wiercigroch, Lidia, Dolibog, Pawel, Stania, Magdalena, Juras, Grzegorz Abstract: International guidelines recommend high-frequency ultrasound (HFUS; MHz) for treating infected pressure ulcers (PUs). A 2-year, prospective, randomized, controlled study was conducted to evaluate how HFUS affects PU healing among 42 geriatric patients treated in four nursing and care centers in Silesia, Poland. Participants (age range 71-95 years,) all with wounds that did not respond to previous treatment for at least 4 weeks, were randomly assigned to the treatment group (TG) (20 with 21 PUs, mean age 83.60 ± 5.04 years) or control group (CG) (22 with 23 PUs, mean age 82.59 ± 6.65 years). All patients received standard wound care (SWC) ; the TG additionally was provided HFUS (1 MHz, 0.5 W/cm2, duty cycle of 20%, 1-3 minutes/cm2; one session per day, 5 days a week). Patients were monitored for 6 weeks or until wounds closed. Percent change in wound surface area (WSA), the Gilmans parameter, the weekly rate of change in WSA, and the percentage of PUs that improved (ie, decreased in size by at least 50% or closed) were used to compare differences. Data were analyzed using Fishers exact test, the Wilcoxon matched pairs test, and the Mann-Whitney U test (P Source: BNI 6.Title: A retrospective, quality improvement review of maggot debridement therapy outcomes in a foot and leg ulcer clinic Citation: Ostomy Wound Management, Jul 2014, vol. 60, no. 7, p. 16-25, 0889-5899 (July 2014) Author(s): Campbell, Noreen, Campbell, Donna Abstract: Maggot debridement is the deliberate use of larvae known to consume only necrotic tissue. A retrospective quality improvement analysis of maggot debridement therapy (MDT) was conducted among patients with devitalized tissue or gangrene attending a Canadian foot and leg ulcer clinic who received MDT between January 2001 and June 2006. MDT was applied every 48 hours until >90% of necrotic tissue was debrided. The authors identified MDT patients in the clinic database and reviewed their medical records for age, gender, presence of diabetes or peripheral arterial disease (PAD), type of wound, number of maggot applications required, wound outcomes, and nursing visit costs (week before, during, and after MDT) and noted patient experiences. Records of 68 patients (average age 71, range 22 to 95, years) were identified and abstracted. Of those, 44% had leg ulcers and 67% had both diabetes and PAD. The majority (39, 58%) of wounds required three debridement sessions. All but one patient achieved debridement of >90% of necrotic tissue in 2 to 10 days. Most wounds (56) healed with follow-up moist wound care. Only one patient withdrew from MDT. No other patient or safety concerns were documented. Total nursing visits for all patients the week before and then after MDT were 307 and 102, respectively. These findings confirm results of previous reports about the effectiveness of MDT for wound debridement. Randomized, controlled clinical studies are needed to confirm the efficacy and cost-effectiveness of MDT compared to other debridement modalities. [Publication] 49 references