Palliative Wound Treatment Promotes Healing
Palliative Wound Treatment Promotes Healing
For Study A, the median age of patients treated was 82. Most patients lived less than 30 days, with a median of 31 days. Healing to closure was not an endpoint in treatment of this cohort as most of the patients would not live long enough for their wound to achieve closure. According to nursing reports, odor and pain were reduced. Pain relief was immediate in most cases, and persisted with use of the novel dressing. In the cases treated, no infections occurred with use of the dressing. Odor was also well controlled. Besides reducing pain, preventing infection, and controlling odor, healing results were surprising. More than 40% of pressure ulcers healed to closure or were healing; 30% of ischemic ulcers were healed to closure or were healing; and more than 40% of neuropathic ulcers were healing (Figure 1). There were no allergic reactions reported. Allergic reaction to lidocaine has been found to be low, < 0.7%. The top dressing used was very successful in that it kept the wound dressing moist and warm, which are both adjuvants to healing, and prevented trauma to periwound skin with dressing changes.
(Enlarge Image)
Figure 1.
Total healing results by wound type. Study A results in the treatment of 231 wounds in hospice patients. Depicted are the 3 most prevalent wound types treated: pressure, arterial (ischemic), and neuropathic (diabetic). Used with permission.
Included in Study A were 24 diabetic foot wounds treated over the 30-month period. Eleven (46%) healed to closure or were healing, no new wound infections presented, and there were no amputations.
A comparison of 231 wounds treated with the novel dressing vs the 92 wounds receiving other treatments is shown in Figure 2. Overall, 40% of wounds treated with the novel dressing healed to closure or were healing vs 10% of wounds treated with other modalities.
(Enlarge Image)
Figure 2.
Comparison of healing rates of novel dressing vs other treatments.
Since the novel dressing uses gauze it is interesting to look at a published study of VAC vs moist gauze healing (Figure 3). Wound volume reduction was assessed at 3 and 6 weeks in 18 patients with chronic nonhealing sacral/pelvic ulcers in each arm of the study. While no direct comparison can be made, the results from 12 hospice patients in Study A with sacral/pelvic ulcers that were examined at 3 and 6 weeks were compared to the published study. Because of the difference in sample sizes, no direct comparison can be made, but results are intriguing, nevertheless, especially since the VAC and gauze arms excluded patients with malnutrition, renal failure, infection, cancer, or other chronic disease requiring treatment, and the novel dressing arm had no exclusions. Patients in the novel dressing arm were also much older, on average 87 years old vs an average of 56 years old in the VAC arm and average 49 years old in the gauze arm.
(Enlarge Image)
Figure 3.
Wound treatment comparison. Comparing novel dressing treatment of hospice patients to published study of vaccum-assisted closure (VAC) vs gauze for sacral/pelvic wounds.
The unpublished results of the use of the novel dressing in nursing home patients is shown in Figure 4. Overall, almost 95% of wounds were closed by 12 weeks. These results can be compared to a study published by the University of Pennsylvania that reported healing rates over 24 weeks of venous and diabetic ulcers.
(Enlarge Image)
Figure 4.
Comparison of healing rates of novel dressing vs other treatments in 72 patients and 156 wounds.
This University of Pennsylvania study was published to demonstrate the expected healing rate using wound treatments that those "skilled in the art"—clinicians who regularly practice wound care, according to the study—would use. The venous ulcer cohort had compression wraps, and the diabetic foot cohort (actually the combined results of 5 different studies) used saline-moistened gauze. These healing rates represent what healing could be achieved with good wound care (ie, standard care), suggesting that any new therapy should be compared against this yardstick. This was used as a comparison for healing rates using the novel dressing. The expected healing rates did not include hospice patients, and patients with peripheral (arterial) vascular disease were excluded in the diabetic foot cohort. Patients in the novel wound dressing arm often had peripheral vascular disease, and a portion were hospice patients, thus making this group less likely to have wounds that healed. The wounds in the novel dressing arm included venous ulcers and diabetic foot ulcers, but also included pressure ulcers, surgical wounds, and arterial wounds. This makes comparison difficult, plus there are fewer data points in the novel dressing arm. The novel dressing arm only followed patients for 12 weeks since healing rates approached 95% by that time, compared to 24 weeks in the University of Pennsylvania study. While a statistical evaluation is not possible, the results are interesting. At 4 weeks, the novel dressing cohort had achieved healing rates equal to the best expected at 24 weeks in the University of Pennsylvania study.
Results
Study A
For Study A, the median age of patients treated was 82. Most patients lived less than 30 days, with a median of 31 days. Healing to closure was not an endpoint in treatment of this cohort as most of the patients would not live long enough for their wound to achieve closure. According to nursing reports, odor and pain were reduced. Pain relief was immediate in most cases, and persisted with use of the novel dressing. In the cases treated, no infections occurred with use of the dressing. Odor was also well controlled. Besides reducing pain, preventing infection, and controlling odor, healing results were surprising. More than 40% of pressure ulcers healed to closure or were healing; 30% of ischemic ulcers were healed to closure or were healing; and more than 40% of neuropathic ulcers were healing (Figure 1). There were no allergic reactions reported. Allergic reaction to lidocaine has been found to be low, < 0.7%. The top dressing used was very successful in that it kept the wound dressing moist and warm, which are both adjuvants to healing, and prevented trauma to periwound skin with dressing changes.
(Enlarge Image)
Figure 1.
Total healing results by wound type. Study A results in the treatment of 231 wounds in hospice patients. Depicted are the 3 most prevalent wound types treated: pressure, arterial (ischemic), and neuropathic (diabetic). Used with permission.
Included in Study A were 24 diabetic foot wounds treated over the 30-month period. Eleven (46%) healed to closure or were healing, no new wound infections presented, and there were no amputations.
A comparison of 231 wounds treated with the novel dressing vs the 92 wounds receiving other treatments is shown in Figure 2. Overall, 40% of wounds treated with the novel dressing healed to closure or were healing vs 10% of wounds treated with other modalities.
(Enlarge Image)
Figure 2.
Comparison of healing rates of novel dressing vs other treatments.
Since the novel dressing uses gauze it is interesting to look at a published study of VAC vs moist gauze healing (Figure 3). Wound volume reduction was assessed at 3 and 6 weeks in 18 patients with chronic nonhealing sacral/pelvic ulcers in each arm of the study. While no direct comparison can be made, the results from 12 hospice patients in Study A with sacral/pelvic ulcers that were examined at 3 and 6 weeks were compared to the published study. Because of the difference in sample sizes, no direct comparison can be made, but results are intriguing, nevertheless, especially since the VAC and gauze arms excluded patients with malnutrition, renal failure, infection, cancer, or other chronic disease requiring treatment, and the novel dressing arm had no exclusions. Patients in the novel dressing arm were also much older, on average 87 years old vs an average of 56 years old in the VAC arm and average 49 years old in the gauze arm.
(Enlarge Image)
Figure 3.
Wound treatment comparison. Comparing novel dressing treatment of hospice patients to published study of vaccum-assisted closure (VAC) vs gauze for sacral/pelvic wounds.
Study B
The unpublished results of the use of the novel dressing in nursing home patients is shown in Figure 4. Overall, almost 95% of wounds were closed by 12 weeks. These results can be compared to a study published by the University of Pennsylvania that reported healing rates over 24 weeks of venous and diabetic ulcers.
(Enlarge Image)
Figure 4.
Comparison of healing rates of novel dressing vs other treatments in 72 patients and 156 wounds.
This University of Pennsylvania study was published to demonstrate the expected healing rate using wound treatments that those "skilled in the art"—clinicians who regularly practice wound care, according to the study—would use. The venous ulcer cohort had compression wraps, and the diabetic foot cohort (actually the combined results of 5 different studies) used saline-moistened gauze. These healing rates represent what healing could be achieved with good wound care (ie, standard care), suggesting that any new therapy should be compared against this yardstick. This was used as a comparison for healing rates using the novel dressing. The expected healing rates did not include hospice patients, and patients with peripheral (arterial) vascular disease were excluded in the diabetic foot cohort. Patients in the novel wound dressing arm often had peripheral vascular disease, and a portion were hospice patients, thus making this group less likely to have wounds that healed. The wounds in the novel dressing arm included venous ulcers and diabetic foot ulcers, but also included pressure ulcers, surgical wounds, and arterial wounds. This makes comparison difficult, plus there are fewer data points in the novel dressing arm. The novel dressing arm only followed patients for 12 weeks since healing rates approached 95% by that time, compared to 24 weeks in the University of Pennsylvania study. While a statistical evaluation is not possible, the results are interesting. At 4 weeks, the novel dressing cohort had achieved healing rates equal to the best expected at 24 weeks in the University of Pennsylvania study.
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