Wound healing is a highly complex natural process, and its failure results in chronic wounds. The causes of delayed wound healing include patient-related and local wound factors. The main local impediments to delayed healing are the presence of nonviable tissue, excessive inflammation, infection, and moisture imbalance. For wounds that can be healed with adequate blood supply, a stepwise approach to identify and treat these barriers is termed wound bed preparation. Currently, a combination of patient-related and local factors, including wound debridement, specialty dressings, and advanced technologies, is available and successfully used to facilitate the healing process.

UNASSIGNED: Debridement is key to removing devitalised tissue, debris and biofilm as part of wound-bed preparation. Unlike many other methods of debridement, mechanical debridement with a pad is effective enough to be used independently without an adjunctive method of debridement, while being more accessible than other standalone options.
UNASSIGNED: To explore the clinical performance and safety of a debridement pad with both abrasive and non-abrasive surfaces in daily clinical practice.
UNASSIGNED: This was a prospective, non-controlled, non-randomised, single-arm, open-label, multicentred observational evaluation. Inclusion criteria were wounds >4 cm2 covered with at least 30% debris, necrotic tissue or slough in patients aged ≥18 years. The treatment protocol comprised a single application of the debridement pad. The primary outcome measure was the amount of necrotic tissue, slough or debris in the wound bed. Secondary outcomes included the appearance of the wound bed, edges and periwound skin; self-reported pain scores; foreseeable negative impacts; and clinician satisfaction.
UNASSIGNED: A total of 62 participants with a variety of wound types were included in the analysis. Most wounds (87%) had been present for over 3 months and had high or moderate exudate levels (90%). A significant reduction was observed in all three parameters: necrotic tissue (p=0.043), slough (p<0.001) and debris (p<0.001). Necrotic tissue, slough and debris showed mean relative reductions of 40%, 72% and 40%, respectively. Of participants, 84% did not experience an increase in pain during the debridement procedure.
UNASSIGNED: This clinical real-world data shows the debridement pad to be an effective and well-tolerated device for debridement and wound bed preparation.

UNASSIGNED: There are several methods of treating hard-to-heal (chronic) wounds, each differing in terms of efficiency, selectivity, speed, cost and pain. The objective is to activate a wound to initiate the healing cascade. For this pilot study we assessed the feasibility of a new microjet wound therapy technology compared to standard sharp debridement in wound outcomes.
UNASSIGNED: A randomised, controlled, open-label pilot study was conducted in one outpatient wound clinic in Western Switzerland from March 2022 to May 2023.
UNASSIGNED: A total of 13 consecutive patients were randomly assigned to receive either microjet wound therapy (n=5) or standard mechanical debridement with instruments (n=8). As a feasibility study, there was insufficient power to detect significant differences between the groups. However, in the intervention group, our analysis may indicate a modestly faster reduction in wound area. Microjet wound therapy appears to alleviate patient anxiety and offer cost savings due to the potential for reduced time, as well as the number of required treatments. This meant fewer overall consultations.
UNASSIGNED: This study highlights a trend that may indicate that microjet therapy holds value in promoting faster healing of hard-to-heal wounds, and it provides a feasibility basis for a sufficiently powered multicentre trial.

UNASSIGNED: The rapidity of wound bed preparation is determined in part by the type of dressing agent employed. The extension phase in which the wound is characterized by the presence of sloughs and eschar and microbial invasion could be managed nonsurgically.
UNASSIGNED: The objective of this study was to compare the rapidity of wound bed preparation using unripe papaya versus honey.
UNASSIGNED: Sixty-four patients were assigned into two equal groups, each dressed, respectively, with unripe papaya or honey. All selected patients were monitored for eschar separation and bacterial clearance time. Data obtained with a pro forma were analyzed with SPSS version 25.
UNASSIGNED: Unripe papaya dressing had a mean eschar separation time of 5.53 ± 2.20 days and bacterial clearance time of 6.81 ± 3.64 days compared to the honey group which had an eschar separation time of 30.09 ± 27.90 days and bacterial clearance time of 15.33 ± 13.62 days. P <0.001 and P < 0.001, respectively, in comparing both outcome measures between the two groups. There was a statistically significant difference in both eschar/slough separation time and bacterial clearance time both in favor of the group prepared with unripe papaya.
UNASSIGNED: The use of unripe papaya was superior to honey in wound bed preparation with respect to eschar/slough separation, bacterial clearance ultimately resulting in reduced length of hospital stay.
Résumé Contexte: La rapidité de la préparation du lit de la plaie est déterminée en partie par le type de pansement utilisé. La phase d\'extension dans laquelle la plaie est caractérisée par la présence de mucosités et d\'escarres et par une invasion microbienne pourrait être gérée de manière non chirurgicale. Objectif de l\'étude: L\'objectif de cette étude était de comparer la rapidité de la préparation du lit de la plaie en utilisant de la papaye non mûre par rapport au miel. Matériels et méthodes: Soixante-quatre patients ont été répartis en deux groupes égaux, chacun habillé respectivement avec de la papaye non mûre ou du miel. Tous les patients sélectionnés ont été suivis pour la séparation de l\'escarre et le temps de clairance bactérienne. Les données obtenues à l\'aide d\'un pro forma ont été analysées à l\'aide de la version 25 de SPSS. Résultats: Le pansement à la papaye non mûre Le temps moyen de séparation de l\'escarre était de 5,53 ± 2,20 jours et le temps de clairance bactérienne de 6,81 ± 3,64 jours pour le groupe papaye non mûre, contre 30,09 ± 27,90 jours pour le groupe miel et 15,33 ± 13,62 jours pour le temps de clairance bactérienne. P < 0,001 et P < 0,001, respectivement, dans la comparaison des deux mesures de résultats entre les deux groupes. Il y a eu une différence statistiquement significative dans le temps de séparation de l\'escarre/du bourbier et dans le temps de clairance bactérienne en faveur du groupe préparé avec de la papaye non mûre. Conclusion: L\'utilisation de papaye non mûre était supérieure au miel dans la préparation du lit de la plaie en ce qui concerne la séparation de l\'escarre/de la pellicule, la clairance bactérienne et, en fin de compte, la réduction de la durée du séjour à l\'hôpital. la durée du séjour à l\'hôpital. Mots-clés: Clairance bactérienne, séparation de l\'escarre, miel, papaye, lit de la plaie.

UNASSIGNED: The effect of artificial highly concentrated carbon dioxide bathing on heat-press-injured wounds has been clinically observed.
UNASSIGNED: A 46-year-old male patient with a heat press injury of the right palmar region achieved complete necrotic tissue removal and sufficient granulation of the skin graft by continuous hand bathing in a solution containing highly concentrated carbon dioxide for four weeks. The patient successfully underwent a full-thickness skin graft from the plantar to the palmar region, and his right hand function improved to the extent that it did not interfere with daily life.
UNASSIGNED: Heat press injuries are often refractory to treatment owing to the synergistic effects of heat and crush injuries. Highly concentrated carbon dioxide bathing has long been known to increase skin and muscle blood flow, and its clinical applications in ischemic limbs, skin ulcers, and osteomyelitis have already been reported. In this case, the results suggest an effect of improved blood flow leading to maturation of the graft bed at the heat-press injury site.
UNASSIGNED: Highly concentrated carbon dioxide bathing is not only clinically applicable to ischemic extremities, skin ulcers, and osteomyelitis, due to increased cutaneous and muscular blood flow, but also to the reliable debridement of heat press injury wounds and the granulation of graft beds. We successfully used this novel combination of procedures to establish a graft bed with a good blood flow despite the deep heat press injury occurring in the palmar region, leading to an excellent functional recovery. The cost per procedure is low, at about $1(USD), making it a wound care option that should be considered from a healthcare economic perspective.

Significance: Burns result in irretrievable cell damage, which can occur upon exposure to hot surfaces, liquids, gases, ultraviolet or ionizing radiation, and through friction. Standard of care in burn management involves protecting the patient, limiting burn progression, and achieving wound closure. Negative pressure wound therapy (NPWT) and NPWT with instillation and dwell time (NPWTi-d) are two wound management options that have been shown to improve outcomes for burn patients in recent years. This work provides a general review of NPWT and NPWTi-d use in burn wound management. A literature search was performed using PubMed and Embase for peer-reviewed publications and conference abstracts written in English and reporting on burn management using NPWT and/or NPWTi-d from a single manufacturer between 2000 and 2021. All burn types were included. Recent Advances: Thirteen studies and 308 patients were available for assessment. Use of NPWT was reported in a majority of studies (n = 11). When conventional NPWT was applied, graft take of >90% was observed and consistent final wound closure was achieved. Two studies described NPWTi-d use for burn wound management. NPWTi-d use promoted granulation tissue development in burn wounds. Critical Issues: Limited high-level prospective evidence exists for use of NPWT and NPWTi-d in burn wound management. Future Directions: Available literature on the use of NPWT and/or NPWTi-d in burn care has reported improved outcomes in wound bed preparation, which can ultimately lead to final wound closure. The use of these modalities should be considered in management of burn care patients.

Debridement is a vital part of wound bed preparation; however, even a perfectly debrided wound may stall if it has vertical edges or the tissue in the wound base does not merge with the wound edges. A novel debridement technique described in this case study allows wound remodelling to overcome these difficulties.

BACKGROUND: Wounds cost £8.3 billion per year in the United Kingdom (UK) annually. Venous leg ulcers (VLUs) account for 15% of wounds and can be complicated to heal, increasing nurse visits and resource costs. Recent wound bed preparation consensus recommends wound cleansing and biofilm disrupting agents. However, inert cleansers such as tap water or saline are inexpensive, an evaluation of evidence is required to justify the higher upfront costs of treatment with active cleansers. We undertook a cost-effectiveness analysis of the use of a biofilm disrupting and cleansing solution and gel, Prontosan® Solution and Gel X, (PSGX) (B Braun Medical), as compared to the standard practice of using saline solution, for treating VLUs.
METHODS: A Markov model was parameterised to one-year costs and health-related quality of life consequences of treating chronic VLUs with PSGX versus saline solution. Costs are viewed from a UK healthcare payer perspective, include routine care and management of complications. A systematic literature search was performed to inform the clinical parameters of the economic model. Deterministic univariate sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) were undertaken.
RESULTS: For PSGX an Incremental Net Monetary Benefit (INMB) of £1,129.65 to £1,042.39 per patient (with a Maximum Willingness to Pay of £30k and £20k per QALY respectively), of which cost savings are £867.87 and 0.0087 quality-adjusted life years (QALYs) gain per patient. PSA indicates a 99.3% probability of PSGX being cost-effective over saline.
CONCLUSIONS: PSGX for the treatment of VLUs is dominant compared with saline solution in the UK with expected cost-savings within a year and improved patient outcomes.

Wound cleansing is a routine element of wound care. However, unnecessary cleansing, inappropriate techniques and inappropriate use of cleansing solutions can negatively affect patient outcomes. Therefore, it is essential that nurses understand when and how to cleanse a wound, and are able to select the most appropriate solution to use based on a holistic wound assessment. Nurses undertaking wound cleansing must have the knowledge and skills required to do so safely and must work within their level of competence. REFLECTIVE ACTIVITY: \'How to\' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of.

BACKGROUND: Chronic wounds affect mainly the productive age group in developing countries and stretch the limited healthcare facility. We aimed to establish the efficacy or otherwise of pawpaw dressing in management of common forms of wounds in resource-poor settings using the Nigerian pawpaw in humans.
METHODS: This study was a prospective research carried out at Alex Ekwueme Federal University Teaching Hospital Abakaliki Nigeria between September 2019 and August 2020 using patients with lower extremity wounds. Thirty patients who had lower extremity wounds that required debridement were enrolled in the study after giving consent. They had wound dressing with unripe pawpaw as an enzymatic debriding agent to evaluate the rapidity of eschar separation and bacterial clearance. The data obtained with a proforma were analyzed using IBM SPSS.
RESULTS: There were 16 males and 14 females with an average wound size of 127.13+ 103cm2. Eschar separation occurred earliest after 3 d of dressing and the latest after 14 d with a mean period of 5.5+ 2.255 days. A case had negative bacterial culture on the first test. Others had a variable period of clearance with a maximum of 18 d and a mean of 6.73+3.750 days. Both eschar separation and bacterial clearance correlated positively with the wound size.
CONCLUSIONS: Wound bed preparation with unripe pawpaw dressing showed promising outcomes with rapid eschar and slough separation, and bacterial clearance resulting in a faster wound healing. This is recommended for wounds needing debridement in which the patients are not fit for anesthesia or could not afford the cost of surgery.