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A Descriptive Survey Study on the Effect of Age on Quality of Life Following Stoma Surgery

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Section: 
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Author(s): 
Selina K. Wong, BSc; Pang Y. Young, MD; Sandy Widder, MD, MHA, FRCSC; and Rachel G. Khadaroo, MD, PhD, FRCSC, on behalf of the Acute Care and Emergency Surgery (ACES) Group of the University of Alberta, Canada

Index: Ostomy Wound Manage. 2013;59(12):16–23.

Abstract

  The number of operative procedures involving the creation of an intestinal stoma is likely to increase as the population ages. Understanding the role of age on postoperative outcomes such as quality of life (QoL) and self-efficacy is critical to developing appropriate supportive strategies. A descriptive survey study was conducted among 18 patients (11 men seven women, age range 47 to 90 years) who had an intestinal ostomy created during a 3-year period at the University of Alberta Hospital in Edmonton, Alberta, Canada. The Stoma Quality of Life Survey and a self-efficacy survey examining self-care, activities of daily living, and instrumental activities of daily living were administered. Patient records were obtained through a retrospective chart review; of the 57 patients identified, 18 were still alive, had not undergone stoma reversal, were cognitively competent, and agreed to participate. Seven patients were <65 years old and 11 were ≥65 years old. Of those, four patients had their stoma since 2009, four patients since 2010, and 10 patients since 2011. Although older patients had more comorbidities and higher mortality following the surgery (46.1% for patients >65 versus 26.1%, for patients <65 years old), no statistically significant difference was found between the two groups for stoma-associated QoL and self-efficacy scores. In patients who had stoma surgery in 2011, older patients on average had higher QoL scores (65.21 versus 61.87, maximum score 100, P = 0.56), but lower self-efficacy scores (32.50 versus 35.25, maximum score 40, P = 0.50). These findings are similar to previously reported study results. However, the small study sample size limits analysis of the variables that may affect QoL in stoma patients. This study supports the need for additional prospective studies to help clinicians develop effective support strategies.

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Managing Severe Dermatitis Caused by Ileal Peristomal Leakage Using a Mushroom-type (de Pezzer) Catheter in Infants: A Case Series

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Author(s): 
Seyed Abbas Banani, MD; and Seyed Javad Banani, MD

Index: Ostomy Wound Manage. 2013;59(12):26–31.

Abstract

  Skin damage secondary to peristomal leakage is a fairly common complication of ileostomies in infants. Traditional conservative measures, including skin barriers, ointments, and agents to reduce bowel movements, initially may be helpful but not in all patients. The purpose of this case series was to describe a new and relatively simple procedure to temporarily manage severe peristomal dermatitis caused by ileal peristomal leakage in infants. After obtaining informed consent from the parents, a mushroom-type (de Pezzer) catheter was inserted into the ileostomy of 11 1- to 4-month-old infants (seven males, four females) with severe peristomal dermatitis. Eight had total aganglionic colon (TAC), two had meconium ileus (cystic fibrosis), and one had meconium peritonitis due to bowel perforation proximal to ileal atresia. The severity of the peristomal dermatitis improved remarkably in all patients after 2 to 3 days. In eight patients, minimal (if any) dermatitis was noted within 5 to 7 days after tube insertion. Six patients who initially had poor weight gain (mean 345 g/month) developed acceptable weight gain (mean 648 g/month) (P<0.03) within 2 to 4 months. In seven patients with TAC, the tube was maintained for 2 to 4 months until definitive pull-through procedure; in four other patients, the tube remained in place for 3 to 7 days as a step for preoperative build-up. None of the patients developed any complications. The procedure requires the presence of a pediatric or trained surgeon, and care must be taken to prevent iatrogenic damage. In this case series, an appropriate-size, mushroom-type (de Pezzer) catheter placed within the ileostomy was a practical mode for temporary control of ileal peristomal leakage that causes severe peristomal dermatitis in infants, particularly in those not responding to medical therapy. Larger studies are needed to develop evidence-based protocols of care for the prevention and management of ileostoma complications in infants.

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A Descriptive Study of Commonly Used Postoperative Approaches to Pediatric Stoma Care in a Developing Country

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Author(s): 
Lofty-John C. Anyanwu, MBBS, MHPM, FWACS, FMCS, FEBPS; Aminu Mohammad, MBBS, FWACS, FICS; and Tunde Oyebanji, MBBS

Index: Ostomy Wound Manage. 2013;59(12):32–37.

Abstract

  Construction of an enterostomy is a common procedure in pediatric surgery. However, caring for the child with a stoma is challenging for parents in developing countries. Modern devices such as colostomy bags and accessories are expensive and not readily available. The purpose of this study was to describe methods of effluent collection and peristomal skin protection used by the mothers of colostomy patients. A prospective, descriptive study was conducted between January and December 2011 during the first three postoperative outpatient clinic visits among mothers of children who had a colostomy constructed in the authors’ hospital. The mothers of 44 children (27 males, 17 females, median age 3.3 months, range 2 days to 11 years) consented to participate. Demographic and clinical data were obtained from the records, and mothers were interviewed and asked to describe their preferred methods of colostomy effluent collection and peristomal skin protection. The stomas also were inspected at each clinic visit. Anorectal malformations were the most common indication for a colostomy (32, 72.73%), followed by Hirschsprung’s disease (11, 25%). Forty-two (42) patients had a divided sigmoid colostomy (95.45%); two patients had a right loop transverse colostomy (4.55%). Nine mothers alternated between two different collection methods. The diaper collection method was described most frequently (22 out of 53; 41.51%), followed by wraparound waistbands (19; 35.85%) and improvised colostomy bags (12; 22.64%). Peristomal skin excoriations were commonly seen within the first 3 weeks postsurgery and had mostly disappeared by the week 6 postoperative visit. Petrolatum jelly was the most commonly used barrier ointment. These locally available, acceptable, and affordable collection methods may be useful for children in other developing countries.

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A Retrospective Analysis of a Human Cellular Repair Matrix for the Treatment of Chronic Wounds

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Author(s): 
Matthew Regulski, DPM; Douglas A. Jacobstein, MD; Russell D. Petranto; DPM, Vincent J. Migliori, DPM; Girish Nair, DPM; and Darelle Pfeiffer, DPM

Index: Ostomy Wound Manage. 2013;59(12):38–43.

Abstract

  Despite the introduction of advanced wound care modalities over the last 15 years, chronic wounds are an increasing problem. Few single options are available for clinicians to treat recalcitrant wounds such as diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs). A retrospective, single-center study was conducted at an outpatient wound care center to evaluate the clinical effect of a human cellular repair matrix (h-CRM) on chronic wounds that had failed to heal. Data from all patients who had received this treatment modality during a period of 2 years were abstracted. Standard care included weekly visits, regular debridement, offloading DFUs, compression for VLUs, and h-CRM for wounds >4 weeks duration. A total of 66 patients (30 male, 36 female, mean age 71.1 [± 8.8] years) received h-CRM treatment for 67 wounds (34 VLUs, 27 DFUs, and six other chronic wounds). The average wound size at baseline was 6.65 (± 9.68) cm2, and the average wound duration before h-CRM treatment was 38 (±70.8) weeks. Fifty (50) patients (74.6%) had failed to heal using other advanced therapies. After 12 weeks of care, 51 of the 67 wounds (76.1%) were healed: 23 of 34 (67.6%) VLUs and 23 of 27 (85.2%) DFUs. Average time to closure in these wounds was 5.8 (±2.5) weeks. No significant differences were found between proportions of VLUs and DFUs healed. No adverse events or recurrences occurred during an average follow-up time of 20.4 months (range 11 to 32 months). Overall, patients received an average of 3.8 applications of h-CRM, and 3.2 applications were used among patients that healed. The study results suggest h-CRM may benefit patients with chronic wounds. Prospective, randomized clinical studies are warranted.

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Providing Quality Skin and Wound Care for the Bariatric Patient: An Overview of Clinical Challenges

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Author(s): 
Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN, CRNP, MAPWCA, FAAN

Index: Ostomy Wound Manage. 2014;60(1):12–21.

Abstract

  Obesity, (defined as body mass index [BMI] ≥30), and especially morbid obesity (defined as BMI ≥40), has a profound impact on the health and integrity of the patient’s integumentary system and on the caregivers who strive to provide care for larger, heavy patients. The purpose of this overview is to address some common skin and wound care issues faced by bariatric patients in order to inform clinicians, patients, and caregivers and enable them to optimize care. For bariatric patients, extra attention must be paid to skin care, cleanliness, skin fold management, perigenital care, odor management, and effective pressure redistribution. Despite these interventions, the multifactorial challenges presented by morbid obesity increase patient risk for serious skin diseases and wound conditions. Implications for practice include how best to educate patients and caregivers for optimal problem prevention. Future research should target improving bariatric care equipment and decreasing risk indices.

Keywords: bariatric, morbid obesity, skin, wound

Potential Conflicts of Interest: none disclosed

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The Role of Obesity in the Patient Undergoing Colorectal Surgery and Fecal Diversion: A Review of the Literature

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Author(s): 
Janice C. Colwell, RN, MS, CWOCN, FAAN

Index: Ostomy Wound Manage. 2014;60(1):24–28.

Abstract

  The obese colorectal surgery patient may face several challenges, including a high risk for the development of colorectal cancer, an increased risk for complications with diverticular disease, and surgical risk factors including anastomotic leaks, inability to perform a low anastomosis, and septic complications. The purpose of this literature review was to examine available data on the implications of obesity on colorectal disease and colorectal surgery, particularly stoma surgery. Obesity has been documented as a risk factor for colorectal disease, but results of studies examining surgery-related problems secondary to obesity are inconsistent. However, clinicians generally believe obese patients undergoing colorectal surgery may be at higher risk of complications than their non-obese counterparts. The obese patient requiring the creation of a fecal diversion may encounter stoma-related issues such as stenosis, retraction, and inability to maintain a consistent pouching system seal. Stoma site marking can be challenging because of the large shifts in subcutaneous tissue and the inability for a person with a large abdomen to be able to visualize the stoma if the stoma is placed too low on the abdomen. Additional research to elucidate complication rates and risk factors is needed to help clinicians develop optimal plans of care.

Keywords: obesity, colorectal surgery, retraction, stenosis, peristomal pressure ulcers

Potential Conflicts of Interest: none disclosed

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Massive Localized Lymphedema, a Disease Unique to the Morbidly Obese: A Case Study

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Author(s): 
Caroline Fife, MD

Index: Ostomy Wound Manage. 2014;60(1):30–35.

Abstract

  Massive localized lymphedema (MLL) is a unique presentation of lymphedema resulting in a large, benign, painless mass that develops in morbidly obese patients, most commonly on the medial thigh. Because nearly 6% of the United States adult population is morbidly obese, MLL is believed to be under-diagnosed. To better guide the clinician in identifying and treating MLL, a case study of a 44-year-old Caucasian woman with type I diabetes who presented to the study wound care clinic with MLL is reported, along with the experience of managing more than 70 patients with MLL. A diagnosis of MLL is usually made based on clinical history and presentation. Routine tissue biopsy is not advisable, and diagnostic tests such as magnetic resonance imaging (MRI) may be impossible due to the morbid obesity of most patients. Complete decongestive physiotherapy (CDP) is recommended. Although surgical removal of the MLL collection may be possible, it is technically difficult and not always advisable due to the risk of perioperative complications, including wound dehiscence. Furthermore, in the author’s experience, recurrence is possible even after surgical removal, particularly if conscientious adherence to compression and weight management do not continue. The advent of advanced pneumatic compression devices designed for the morbidly obese and the possibility of using near-infrared fluorescence imaging to guide treatment may transform the MLL management process. Considering the increasing number of MLL cases, the comorbidities and complexities of treating morbidly obese patients, and associated complications, clinicians caring for the morbidly obese need a heightened awareness of this condition.

Keywords: morbid obesity, lymphedema, intermittent pneumatic compression, manual lymphatic drainage, compression bandaging

Potential Conflicts of Interest: Dr. Fife is Chief Medical Officer, Intellicure, Inc, The Woodlands, TX.

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A Pictorial Overview of Technology-assisted Care Options for Bariatric Patients: One Hospital’s Experience

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Author(s): 
Margaret Arnold, PT, CEES, CSPHP; Elizabeth Roe, RN, PhD; and Deborah Williams, RN, BSN, MA, CWOCN

Index: Ostomy Wound Manage. 2014;60(1):36–42.

Abstract

  Best practice guidelines to avoid pressure ulcers and skin breakdown among obese patients include early and progressive mobility, rigorous turning schedules, and proper skin care. However, implementation of some these guidelines may increase the risk of patient and caregiver injury. An acute care hospital implemented safe patient handling protocols that involved equipment purchase and extensive training for all care staff. The new equipment facilitated repositioning, including boosting and turning, lateral transfers, vertical transfers and ambulation, and bathing and toileting. All healthcare facilities are expected to see an increase in the number of bariatric patients and need for safe patient handling protocols and procedures. At the same time, research is needed to evaluate the safety, effectiveness, and cost-effectiveness of currently available devices designed to improve patient safety and reduce caregiver injury.

Keywords: bariatrics, obesity, moving and lifting patients, patient care, equipment and supplies

Potential Conflicts of Interest: Ms. Arnold provides consulting services for several safe patient handling and mobility companies.

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Tissue Changes in Patients Following Spinal Cord Injury and Implications for Wheelchair Cushions and Tissue Loading: A Literature Review

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Author(s): 
Amit Gefen, PhD

Index: Ostomy Wound Manage. 2014;60(2):34–45.

Abstract

  Persons using wheelchairs, especially those with spinal cord injuries (SCI), may be susceptible to tissue changes that affect their risk for pressure ulcer (PU) development. To examine the complexity of the problem of designing, selecting, and prescribing an optimal cushioning solution to help prevent PUs, a literature search was conducted examining factors that affect the biomechanical interactions of the seated buttocks with the cushion and how these factors may change over time. The majority of publications retrieved were preclinical studies and case studies, and just a small fraction was randomized clinical trials. The literature indicates that external and internal anatomy and tissue structure and function change considerably in the months and years following the loss of sensation and mobility. Specifically, these changes typically include weight and fat mass gain, skeletal muscle atrophy and fat infiltration into muscles, bone loss and bone shape adaptation at the pelvis, vascular perfusion changes, and microstructural changes in skin and muscle that are associated with disuse and affect the biomechanical behavior of these tissues. Support surfaces, particularly wheelchair cushions, should be designed to accommodate microchanges that occur for a seated person throughout the day (eg, changes in posture and position or muscle tone) as well as macrochanges in anatomy, tissue composition, and long-term tissue (patho)physiological changes. Cushions must be tailored to, and adapted for, each individual patient on a regular basis. A promising and practical bioengineering approach to fit cushions to different patient conditions is to use computer simulations (finite element [FE] modeling). As understanding about PU risk in this population increases, study designs can be refined to develop a much-needed evidence-base for the appropriate use of support surfaces in general and wheelchair cushions in particular.

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A Cross-sectional Study of Depression and Self-Care in Patients With Type 2 Diabetes With and Without Foot Ulcers

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Author(s): 
Camila Ribeiro Coelho, MS; Denise Engelbrecht Zantut-Wittmann, MD, PhD; and Maria Cândida Ribeiro Parisi, MD, PhD

Index: Ostomy Wound Manage. 2014;60(2):46–51.

Abstract

  Depression has been recognized as a risk factor for foot ulceration in persons with diabetes mellitus. Using convenience sampling methods, a cross-sectional study was conducted among persons with type 2 diabetes treated in a diabetic foot clinic in Sao Paulo, Brazil between February 2010 and December 2011. One hundred (100) patients (average age 62 years, range 38 to 83 years), 50 with a foot ulcer and 50 at risk for developing a foot ulcer, participated. Symptoms of depression were assessed using the Beck Depression Inventory (BDI), where scores increase with severity; and patients were interviewed about foot self-care behaviors. Average BDI scores among patients with an ulcer were higher (mean 20.37; range 1 to 42) than those of patients that had not developed a foot ulcer (mean 15.70; range 2 to 49) (P = 0.030). Self-care behavior was not significantly different between the two groups. Severe depression (P = 0.049, OR= 6.56 95% CI 1.01–42.58) and male gender (P<0.001, OR=14.87 95% CI 3.83–57.82) were associated with the presence of a foot ulcer. Despite reported adequate self-care behaviors, patients with an ulcer had more symptoms of depression than patients who were at risk for developing a foot ulcer. Studies examining cause-and-effect relationships between these observations and the potential role of depression interventions are needed. The results of this and other studies suggest depression screening is important in patients with diabetes mellitus and foot ulcers.

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Low-frequency Ultrasound for Patients With Lower Leg Ulcers Due to Chronic Venous Insufficiency: A Report of Two Cases

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Author(s): 
Sara F. Maher, DScPT; Jessica Halverson, DPT; Rob Misiewicz, DPT; Trisha Reckling, DPT; Ojas Smart, DPT; Carol Benton, BSN, RN, CWCN; and Dawn Schoenherr, RN, MSN, CS, CCRN

Index: Ostomy Wound Manage. 2014;60(2):52–61.

Abstract

  Low-frequency ultrasound may facilitate debridement and healing of chronic wounds, including lower leg wounds in patients with chronic venous insufficiency (CVI). To evaluate the use of a low-frequency ultrasound (LFU) device with a curette, two patients with CVI and chronic wounds were treated for a period of 2 to 3 weeks. A 63-year-old woman with rheumatoid arthritis and two wounds, one on the right lower leg (250 cm3) and one wound on the left medial leg (0.80 cm3), present for 12 months; and a 77-year-old man with cardiopulmonary issues with seven wounds, three on the left medial calf (1.2 cm3, 11.40 cm3, and 0.72 cm3), one on the left anterior calf (0.30 cm3), two on the right posterior calf (0.90 cm3, 0.30 cm3), and one on the right anterior calf (0.14 cm3), present for 3 months consented to participate in the study. Both patients received low-intensity (50–70 m), low-frequency (35 kHz) ultrasound at an intensity of 50% through a saline mist in addition to antimicrobial dressing with silver, a multilayer compression bandage system applied at every visit, and pain medication as needed. Both patients received treatments every 1 to 3 weeks that were not timed. Treatment continued until no additional slough or other necrotic tissue could be removed from the wound bed; the female patient received two treatment sessions and the male received three. Average wound volume did not change significantly from the first to last treatment session (t(8) – 1.2, P = 0.26). Five wounds (56%) with initial measurements of 0.8 cm3, 0.72 cm3, 0.3 cm3, 0.3 cm3, and 0.14 cm3 reduced in volume by 100%. Mean wound characteristic scores changed significantly (P<0.05) for amount of fibrin, periwound skin, drainage amount, and color. In addition, the number of wounds filled with slough decreased from 89% at the first session to 22% at the final treatment session. The results of this study suggest LFU may have been beneficial for these patients with CVI. Additional studies using larger sample sizes are needed to evaluate the effect of this treatment on a variety of chronic wounds and to compare its effectiveness to other debridement methods.

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The Reliability and Validity of Color Indicators Using Digital Image Analysis of Peristomal Skin Photographs: Results of a Preliminary Prospective Clinical Study

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Author(s): 
Shinji Iizaka, PhD; Mayumi Asada, MHS; Hiroe Koyanagi, MHS; Sanae Sasaki, BSN; Ayumi Naito, MHS; Chizuko Konya, PhD; and Hiroma Sanada, PhD

Index: Ostomy Wound Manage. 2014;60(3):12–29.

Abstract

  Accurate assessment is necessary to evaluate peristomal skin condition, but objective methods are lacking. The purpose of this prospective, repeated-measures study was to evaluate the reliability and validity of color indicators using digital image analysis of peristomal skin photographs. The 6-month study was conducted among 21 patients (mean age 65.1 years old, 15 men) with ostomies (14 colostomies, six ileostomies, and one urostomy) at four outpatient clinics. Photographs taken by nurses of the peristomal area using point-and-shoot cameras were processed using digital image analysis, which involved color calibration, image processing, and indicator calculation. An erythema index (EI), melanin index (MI), and hypopigmentation index were created to represent increased degrees of red, black, and white color, respectively, and their average values in the peristomal region of an image were calculated relative to values for intact skin.

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Use of a Portable, Single-use Negative Pressure Wound Therapy Device in Home Care Patients with Low to Moderately Exuding Wounds: A Case Series

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Author(s): 
Theresa Hurd, RN, MScN, PhD; Paul Trueman, BA, MA; and Alan Rossington, MEng, MSc

Index: Ostomy Wound Manage. 2014;60(3):30–36.

Abstract

  Negative pressure wound therapy (NPWT) is widely used in the management of acute and chronic wounds. The purpose of this 8-week study was to evaluate outcomes of using a new canisterless, portable, single-use NPWT system in patients with wounds treated in a Canadian community healthcare setting. The device is designed to provide negative pressure at 80 ± 20 mm Hg, 24 hours a day of continuous usage, for a maximum wear time of 7 days. Data on wound outcomes, including exudate levels, wound appearance, and wound area, were collected weekly by a Registered Nurse as part of routine practice.

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Loofah Sponge as an Interface Dressing Material in Negative Pressure Wound Therapy: Results of an In Vivo Study

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Author(s): 
Umut Tuncel, MD; Aydin Turan, MD; Fatma Markoc, MD; Unal Erkorkmaz, PhD; Cigdem Elmas, MD; and Naci Kostakoglu, MD

Index: Ostomy Wound Manage. 2014;60(3):37–45.

Abstract

  Since the introduction of negative pressure wound therapy (NPWT), the physiological effects of various interface dressing materials have been studied. The purpose of this experimental study was to compare the use of loofah sponge to standard polyurethane foam or a cotton gauze sponge. Three wounds, each measuring 3 cm x 3 cm, were created by full-thickness skin excision on the dorsal sides of 24 New Zealand adult white rabbits. The rabbits were randomly divided into four groups of six rabbits each. In group 1 (control), conventional saline-moistened gauze dressing was provided and changed at daily intervals. The remaining groups were provided NPWT dressings at -125 mm Hg continuous pressure.

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An In vitro Analysis of the Effects of Various Topical Antimicrobial Agents on Methicillin-resistant and Methicillin-sensitive Strains of Staphylococcus aureus

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Author(s): 
Michael Kaiser; Joel Gil, BS; Ryan Treu, BS; Jose Valdes; and Stephen Davis, BS

Index: Ostomy Wound Manage. 2014;60(4):18–28.

Keywords:Staphylococcal skin infection, methicillin-resistant Staphylococcus auerus, drug resistance, bacteria, wound

Abstract

  Infections of acute and chronic wounds have a substantial negative impact on patient outcomes. Because bacterial resistance to traditional antimicrobials continues to increase, an in vitro study was conducted to examine current sensitivities of various methicillin-resistant and methicillin-sensitive strains of Staphylococcus aureus (MRSA and MSSA) to commonly used topical antimicrobial agents. Using fresh cultures of eight strains of MRSA and MSSA, the area of the zone of inhibition produced by various topical antimicrobials, including an aminoglycoside antibiotic, monocarboxylic acid antibiotic, pleuromutilin antibiotic, triple antibiotic ointment, and petrolatum ointment, was examined.

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A Prospective Two-armed Trial Assessing the Efficacy and Performance of a Silver Dressing Used Postoperatively on High-risk, Clean Surgical Wounds

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Author(s): 
Jamie Schwartz, MD; Selena Goss, MD; Federico Facchin, MD; Fotini Manizate, MD; Cynthia Gendics, RN; Elissa Braitman, MD; and John Lantis, MD

Index: Ostomy Wound Manage. 2014;60(4):30–40.

Keywords:clinical study, surgical site infection, dressings, silver dressing

Abstract

  Surgical site infections (SSI) are a known complication of surgery. Silver-containing wound treatments are popular, despite the lack of evidence of SSI reduction. A two-armed study was conducted between July 2007 and November 2008 to evaluate the efficacy and ease of use of a postoperative silver dressing. In the first arm of the study, patients undergoing clean general, vascular, orthopedic, and neurosurgical procedures were allocated to receive a postoperative silver dressing (POSD) or a standard dressing of nonstick gauze under a fluid occlusive dressing.

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A Retrospective Comparison of Perforator and Rotation Flaps for the Closure of Extensive Stage IV Sacral Pressure Ulcers

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Author(s): 
Masaki Fujioka, MD, PhD; Kenji Hayashida, MD; Sin Morooka, MD; and Hiroto Saijo, MD

Index: Ostomy Wound Manage. 2014;60(4):42–48

Keywords:case series, pressure ulcers, perforator flap, rotation flap, postsurgical complications

Abstract

  Wound coverage using a flap, most commonly a perforator or rotation flap, often is required for the closure of extensive sacral pressure ulcers. To assess the duration of wound healing and postsurgical complications following two types of surgical closure procedure, perforator and rotation flaps, a retrospective study was conducted among a convenience sample of 20 patients (10 men, 10 women) with Stage IV sacral pressure ulcers. All ulcers were repaired in 2011 and 2012 by the same surgical group and included nine perforator and 11 rotation flaps. Patient demographic and wound outcomes data were abstracted, and data were analyzed using Wilcoxon signed rank and chi-squared tests.

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Interchangeable Skin Grafting to Camouflage Self-inflicted Wound Scars on the Dorsal and Volar Forearm: A Case Report

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Author(s): 
Chang-Yi Chou, MD; Hsin An Chang, MD; Hao-Yu Chiao, MD; Chi-Yu Wang, MD; Yu-shan Sun, MD; Shyi-gen Chen, MD, MPH; and Chih-Hsin Wang, MD

Index: Ostomy Wound Manage. 2014;60(4):50–52.

Keywords:case study, self-mutilation, scars, skin transplantation

Abstract

  Scars from self-inflicted wounds to the upper extremities are the hallmark of self-mutilation. They are easy to recognize and difficult to hide. Camouflaging these scars can be an onerous task. In this case study, a 23-year-old woman who has major depressive disorder with comorbid borderline personality disorder presented for scar repair of self-inflicted wounds on the volar and dorsal forearm (each approximately 10 cm2 x 15 cm2). Following a psychological and physical evaluation, split-thickness skin grafts (10/1,000 inches in thickness) were obtained from both areas and switched. The grafts were fixed with staples, immobilized with a short arm splint, and dressed daily with gauze and neomycin ointment. Staples were removed after 10 days; at the 6-month follow up, the wounds resembled burn wound scars. The patient was satisfied with this more socially acceptable result. This method might offer a simple camouflage option in appropriately selected cases.

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A Multicenter, Retrospective Study to Evaluate the Effect of Preoperative Stoma Site Marking on Stomal and Peristomal Complications

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Author(s): 
Zehra Gocmen Baykara, PhD, RN; Sevil Guler Demir, PhD, RN; Ayise Karadag, PhD, RN; Deniz Harputlu, PhD, RN; Aysel Kahraman, ETN, RN; Sercan Karadag, ETN, RN; Aysel Oren Hin, ETN, RN; Eylem Togluk, ETN, RN; Meral Altinsoy, ETN, RN; Sonca Erdem, ETN, RN; and Rabia Cihan, ETN, RN

Index: Ostomy Wound Manage. 2014;60(5):16–26.

Keywords:surgical stoma, postoperative complications, nursing, multicenter trials, retrospective study

Abstract

  Even though preoperative marking of the stoma area is considered important for the prevention of postoperative complications, not all healthcare institutions have universally adopted this practice. A multicenter, retrospective, descriptive study was conducted to determine the effect of stoma site marking on stomal and peristomal complications.

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A Survey to Assess Knowledge Among International Colorectal Clinicians and Enterostomal Therapy Nurses About Stoma-related Faith Needs of Muslim Patients

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Author(s): 
Fareed Iqbal, MBChB, MRCS (Eng), BMedSc; Zainab Batool, MBChB; Sarah Varma, BSc(Hons), RGN; Douglas Bowley, MBBS, FRCS(Eng); and Carolynne Vaizey, MD, FRCS (Eng), FCS(SA), MBChB

Index: Ostomy Wound Manage. 2014;60(5):28–37.

Keywords:stoma, Islam, survey, healthcare practices

Abstract

  Quality of life after the creation of a stoma can be influenced by religious factors. Enterostomal specialist nurses often offer holistic preoperative counseling to discuss religious concerns with Muslim patients, which requires a sound working knowledge of relevant Islamic practices. To assess colorectal surgeon and enterostomal specialist nurse awareness of Islamic practices that influence quality of life in Muslim patients with stomas, a questionnaire comprised of 16 multiple-choice questions was developed and face and content validity established.

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