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Effectiveness of topical negative pressure for treating chronic wounds - Dissertation Example

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Effectiveness of topical negative pressure for treating chronic wounds

Assessment of the effects on secondary outcomes did not show significant difference between TNP and control. However, the high number of methodological issues make most of these studies of poor quality, compromised validity, and high potential for bias. Thus, future RCTs should be large-scale, blinded, and with intention-to-treat analysis to make its findings significant. CHAPTER 1 Introduction Chronic wounds Wounds are said to be chronic if they take a long time to heal, if they fail to heal despite treatment, or recur (Azad and Nishikawa, 2002; Ubbink, et al., 2008). Werdin, et al. (2009) defines it as wounds that are persisting for more than or equal to three months. 1. Causes All wounds have a potential to become chronic, and as such should be treated based on their etiology, either venous insufficiency, arterial perfusion, or unrelieved pressure. Poor nutrition, immunosuppression, and infection further promote the progression of wounds to chronic state. The most common chronic wounds are located at the lower extremity, and are caused by vascular pathology or diabetes (Werdin, et al., 2009). Because those in the elderly population are the ones more prone to have such factors, chronic wounds are mostly found among the geriatrics, together with individuals with multiple health problems (Azad and Nishikawa, 2002). 2. Pathogenesis Wound healing occurs through a cascade of hemostasis, inflammation, proliferation and remodelling. Chronic wounds, start as acute wounds, although they become trapped in the inflammatory phase, and are thus persistently red, swollen, painful, and fluid-filled. The persistence of inflammation is sometimes promoted by the presence of bacteria in the wound site. At this time, the most common genes expressed were for cell death. The senescent cells persisting in chronic wounds make fibroblasts irresponsive to growth hormone, making the wound incapable of traversing through the next steps of the cascade (Leffler, et al., 2011). 3. Principle of treatment The Wound Healing Society has suggested the TIME acronym to guide healthcare providers in managing chronic wounds. The first letter represents “Tissue”, which means that treatment should first involve removal of impediments to healing, such as devascularized tissue, necrotic material, and excessive bacteria. These can be done through surgical debridement, mechanical debridement by curettage or waterjet, application of enzymatic agents like collagenase and papain-urea derivatives, dressings with autolytic hydrocolloid material, as well as biological interventions like infestation with maggots. Currently, there is still no definitive evidence that supports the use of a single form of debridement, although surgical debridement is generally regarded as fast and effective. Next, “Infection” should be managed through topical or systemic antibiotics. Surgical debridement also decreases bacterial load considerably. Then, “moisture” should be provided to prevent friction and resulting pain in the area. Many dressings, hydrocolloids, paraffin gauze and saline-moistened dressing, are being used to give a moist environment for the wound. Finally, letter E is for “Edge of the wound”, which means that the quality of wound edge should be monitored to assess the progress of healing. It should be determined whether the ulcer size is decreasing (Werdin, et al., ...Show more
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ABSTRACT Chronic wounds are becoming more commonly managed using topical negative pressure. The evidence supporting the device’s clinical use is evaluated in this literature review. Randomized controlled trials (RCTs) were searched from the PubMed database, and one meta-analysis, five were systematic reviews, and three RCTs were obtained, and three systematic reviews plus one RCT were discussed in detail…
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