Significance: Nutrition is one of the most basic of medical issues and is often ignored as a problem in the management of our chronic wound patients. Unfortunately, malnutrition is widespread in our geriatric patients even in nursing homes in developed countries. Attention to basic nutrition and providing appropriate supplements may assist in the healing of our chronic wounds. Recent Advances: Recent research has revealed the epidemiology of malnutrition in developed countries, the similarities to malnutrition in developing countries, and some of the physiologic and sociologic causes for this problem. More information is now available on the biochemical effects of nutrient deficiency and supplementation with macronutrients and micronutrients. In some cases, administration of isolated nutrients beyond recommended amounts for healthy individuals may have a pharmacologic effect to help wounds heal. Critical Issues: Much of the knowledge of the nutritional support of chronic wounds is based on information that has been obtained from trauma management. Due to the demographic differences of the patients and differences in the physiology of acute and chronic wounds, it is not logical to assume that all aspects of nutritional support are identical in these patient groups. Before providing specific nutritional supplements, appropriate assessments of patient general nutritional status and the reasons for malnutrition must be obtained or specific nutrient supplementation will not be utilized. Future Directions: Future research must concentrate on the biochemical and physiologic differences of the acute and chronic wounds and the interaction with specific supplements, such as antioxidants, vitamin A, and vitamin D. SCOPE AND SIGNIFICANCEThis review discusses the current knowledge of nutrition as related to the patient with chronic wounds. We describe the demographic and physiologic differences between acute and chronic wound patients and define the problem of malnutrition in developed countries. A basic understanding of the need for macronutrients and micronutrients and the value of specific supplementation is provided. TRANSLATIONAL RELEVANCEMuch of the current knowledge of nutrition in relation to wound healing is inferred from the management of acute wounds and may not be relevant to the patient with chronic wounds. This review describes the current state of available research on the topic and demonstrates the limitations of this information to guide future research. Additional studies that evaluate the supplementation with specific nutrients in patients with chronic wounds will translate into improved patient care. CLINICAL RELEVANCEThis review provides the clinician with knowledge of basic nutrition, the epidemiology of malnutrition in the chronic wound patient, and how to screen these patients for malnutrition. The reader will recognize that even an obese patient may have specific nutrient deficiencies. The literature is reviewed regarding the value of macronutrient and micronutrient supplementation. Recommendations f...
Background: The medicinal use of maggots for the biological debridement of chronic wounds is increasing around the world, due to its efficacy, safety and simplicity. Thousands of patients have been treated in private and governmental hospitals during the last 10 years. Objective: To examine the efficacy of maggot debridement therapy (MDT) in the debridement of chronic wounds in a militaryhospital. Methods: MDT was applied for 1–9 days to 7 male and 4 female soldiers or their family members (21–72 years old) with chronic wounds. Results: Complete debridement was achieved in 10 out of 11 patients, while in 1 patient the wound could be cleaned only partially. A remarkable reduction in the odor emanating from the wound and notable granulation were observed in all debrided wounds. Increased pain was observed in 1 patient with a venous stasis ulcer. Conclusion: We believe that MDT is a rapid and effective method for the debridement of chronic wounds in a military environment especially in times of war in developing countries.
Objective: We present a patient who developed visual loss after carbon monoxide (CO) poisoning and was treated with hyperbaric oxygen. Clinical Presentation and Intervention: A 21-year-old woman poisoned with CO (with coma lasting 4 h and carboxyhemoglobin level 46%) developed seizures and cortical blindness 3 days after poisoning. Four years later, her visual acuity was 0.2 in both eyes. An 18F-fluorodeoxyglucose positron emission tomography (PET) scan showed reduced metabolism in the bilateral posterior temporal and occipital lobes. The patient received a total of 50 hyperbaric oxygen sessions over 3 months for visual loss and the visual acuity improved to 0.5 in both eyes. In addition, increased metabolism was detected in the brain in post-treatment PET scans. Conclusion: PET documented brain hypoperfusion 4 years after CO poisoning and hyperbaric oxygen therapy improved visual acuity. However, we cannot endorse routine use of hyperbaric oxygen for such patients, until results of further clinical trials demonstrate efficacy of hyperbaric oxygen in CO-induced chronic brain injury.
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