Chronic wounds are a growing problem in the UK, impacting on patients quality of life as well as vital healthcare resources. Preventing and managing biofilms is fast becoming a primary objective in wound care treatment. Poloxamer-based surfactants, which target biofilms, are emerging as an effective treatment of chronic wounds. Surfactants have been shown to play an active role in cleansing, desloughing, debridement, prevention, disruption and removal of biofilms. This article explores the role of biofilms in wound development — how to prevent, identify and treat them. It also looks at surfactants, such as poloxamer, which is showing promising results in the management of wound biofilm. One particular poloxamer-based surfactant, known for its anti-biofilm capabilities and contained within the UCS™ debridement cloth, is discussed in this article.
Skin tears are a common type of tissue injury, which often go unrecognised and misdiagnosed. Furthermore, classification and documentation of skin is often poor, resulting in chronic wounds with associated adverse patient outcomes. The International Skin Tear Advisory Panel (ISTAP) recently updated the International Best Practice Guidelines and definition of a skin tear based on emerging evidence and expert discussion and consensus. This article presents a discussion of the epidemiology, risk factors and causes of skin tears. In addition, the most recent best practice recommendations for the prevention, assessment, and management of skin tears is summarised.
The suboptimal management of leg ulcers has been identified as a UK-wide problem that involves a high financial and personal cost (Guest et al, 2015). One common omission identified in the care of patients with a leg ulcer is a failure to establish the underlying aetiology of the wound. Ideally, an accurate leg ulcer diagnosis should initiate the appropriate therapy, which should, in turn, facilitate healing; however, an inaccurate diagnosis at the outset means that the patient may not be started on an appropriate management pathway. Although vascular disorders are the major cause of leg ulcers, there are other aetiologies that should be considered when the leg ulcer has failed to respond to evidencebased therapy (Rayner et al, 2009). This article outlines some of the atypical leg ulcer types the author has encountered, as well as detailing the signs that were identified within the assessment process and which allowed the author to formulate an accurate diagnosis.
Evidence suggests that biofilm is present in at least 78% of nonhealing wounds, and it is widely accepted that its presence may be a cause for delayed healing in some patients. As the majority of chronic wounds are managed in a community setting, it is important that clinicians have an understanding of what biofilm is, how to identify its presence in the wound, and how to carry out biofilm-based wound care (BBWC). AQUACEL® Ag+ Extra™ is a unique dressing that has been specifically designed to manage biofilm. It combines antimicrobial and anti-biofilm components, which work in synergy to successfully disrupt biofilm, expose microorganisms to the broadspectrum antimicrobial activity of ionic silver in chronic wounds and to help prevent biofilm re-formation, thus making it worthy of inclusion in the biofilm care pathway.
Almost one adult in 20 in the UK has a wound, while the NHS cares for 2.2 million people with wounds annually. Most of the people in the UK with a wound are managed in primary care by nurses (Guest et al, 2015). Some wounds, such as minor burns, cuts, abrasions and surgical wounds, heal quickly and with minimal intervention. However, over half of all wounds go on to become chronic, with approximately 39% of these failing to heal after 12 months (Vowden and Vowden, 2009). One of the basic tenets of evidence-based wound care is choosing the correct dressing. This article discusses the management of chronic wounds in the community and provides guidance for community nurses on choosing appropriate dressings.
