Wound Practice and Research

This literature review assesses the most recent data to summarise the emerging potential uses, benefits and risks of pulsed electromagnetic field therapy (PEMF) in wound healing. Electromagnetic fields have mainly been used as an adjunct therapy for osteoarthritis and other diseases involving joints. However, PEMF has also been shown to influence various signalling molecules involved in wound healing, including MMP‑2, IL‑6 and TGF‑β. Therefore, studies have begun to explore the use of PEMF in other diseases, such as incision wound repair, diabetes-related foot ulcers (DFU) and pressure ulcers. However, the cellular response to PEMF is highly variable and likely influenced by multiple factors – frequency, duration, tissue type, stage of wound repair and field strength. This high degree of variability may explain why PEMF seems to promote cell proliferation under certain conditions and inhibit cell growth with different parameters. This review highlights the need for further research to determine precisely how different variables influence PEMF therapy. Before PEMF can be implemented widely in clinical practice, this review provides a starting point for further controlled trials. This review might also provide a solid base to propose standardised experimental guidelines to investigate PEMF efficacy in wound healing, ulcer treatment and type 2 diabetes.

Background In 1937, oral phenytoin medication was introduced as an anti-epileptic drug. For many years, researchers have shown interest in how topical phenytoin may be used to promote wound healing in various wounds.

Purpose This review article aims to summarise and critically appraise the clinical evidence available on the effects of topical phenytoin on wound healing.

Methods By using the keywords phenytoin, injuries, wound, wound care, and wound healing, we extracted articles published up to April 2022 through a search in PubMed, ISI Web of Science, SID, Google Scholar and Scopus.

Result We identified 17 studies performed on human subjects and eight on rats. Phenytoin effectiveness is also compared with other wound care substances, including tretinoin, silver sulfadiazine, EUSOL, honey, dexamethasone and hypericin.

Conclusion This review illustrated the significant effects and rare adverse events of topical phenytoin on wound healing.

Aim To undertake a scoping review of research on the assessment, management and prevention of acute wounds, from both primary research studies in Australia and from worldwide synthesised evidence, in order to provide a global context of future research needs.

Methods Databases, trial registries and professional organisation websites were searched from January 2010 to April 2022 inclusive. All Australian research studies, in addition to worldwide reviews and guidelines, were included. Articles were reviewed by two independent researchers and conflicts were resolved by a third researcher. Results were synthesised in a narrative review.

Results The searches yielded 318 Australian studies and 833 international studies, the latter comprising of 680 systematic reviews (SRs), 28 evidence-based guidelines (EBGs), 79 evidence summaries and 46 consensus documents. The Australian research studies consisted mostly of cohort studies, focused on burns (46%) and surgical wounds (44%), with fewer studies on skin tears and other acute wound types. Australian studies were primarily investigating wound management or treatments (60%), with only 38% on assessment and 2% on the prevention of wounds.

Conclusions This review found research on acute wounds focused on surgical wounds and burns, with gaps in research on skin tears or traumatic wounds, wound prevention, and research in primary healthcare settings, despite the high prevalence of wounds cared for in these settings.

Aim Hospital-acquired pressure injuries (HAPI) are preventable yet continue to occur. This study aimed to reduce HAPI by implementing a combined occupational therapy and nursing preventive approach to pressure care management, utilising pressure redistribution cushions and enhanced patient education.

Methods A case-control design whereby inpatients in an acute hospital setting were provided with the pressure care intervention. The control group received usual care and were retrospectively audited. Outcome measures included incidence, location, and stage of pressure injuries, Waterlow Risk Assessment (WRA) scores and hospital length of stay. Nursing staff were surveyed regarding the acceptability of the intervention and implementation barriers.

Results A total of 314 patients were recruited, with 23 pressure injuries identified (control group n=13/147 vs. intervention group n=10/167, p=0.122). In the control group, 62% (n=8) of pressure injuries were hospital-acquired, compared to 10% (n=1) in the intervention group (p=0.007). One hundred percent of nursing staff that completed the survey (n=7) agreed that the intervention was acceptable. However, gaps in implementation were noted with 45% of patients initially receiving education and 38% a pressure redistribution cushion.

Conclusions The pressure care intervention significantly reduced rates of HAPI; however, barriers exist to consistently implementing these interventions which require consideration and management.

During the COVID-19 pandemic, healthcare professionals in Singapore were required to wear N95 masks as part of their personal protective equipment. This led to multiple cases of facial device-related pressure injuries (DRPIs).

Aim A quality improvement project was conducted to investigate the effectiveness of silicone transparent adhesive tape in reducing DRPIs in an inpatient hospice setting.

Method A pre-intervention survey was conducted to determine the prevalence of DRPIs among healthcare professionals, and a post-intervention survey was administered to assess the effectiveness and staff perceptions regarding of the use of prophylactic silicone adhesive tape.

Results Overall, 67.2% (n=45) of healthcare professionals had one or more DRPIs, during the pre intervention survey which resulted in discomfort, lowered their self-esteem, and reduced their ability to concentrate. Following the application of the prophylactic silicone adhesive tape to the facial nasal bridge and bilateral cheekbones (n=29), 82.7% (n=24) of participants reported greater comfort and would recommend the intervention to others, as it improved their physical and mental well-being, and their ability to concentrate at work.

Conclusion The prophylactic application of transparent adhesive silicone tape under respiratory masks during COVID-19 has been shown to be a successful intervention in the inpatient hospice setting. Its continued use whenever facial masks need to be worn is recommended.