Evidence‐based topical management of chronic wounds according to the T.I.M.E. principle

Microbiology diagnostics are frequently performed in patients with chronic wounds. However, there is currently a lack of uniformity with respect to indications as well as the practical implementation of such workup. The fact that diagnostic results may be significantly affected by the sampling technique used as well as the preceding (wound) preparation underscores the need for uniform standards, which have been missing so far. In Germany, bacteriologic wound swabs are routinely performed, particularly with the intent to screen for multiresistant pathogens. For this indication, prior wound cleansing should be avoided, and sampling using the Essen Rotary technique provides a quick and easy-to-use option. If there is clinical suspicion of an infection, wound cleansing with sterile saline solution (0.9 %) and/or sterile cotton gauze should be carried out prior to obtaining bacteriologic swabs. While routine diagnostic biopsies are generally not required in chronic wound patients, they may be useful in case of clinically suspected wound infections, particularly in patients with deep ulcerations, diabetic foot syndrome, severe soft tissue infection, or fistula tissue. Moreover, biopsies are indispensable in the microbiology workup of specific pathogens such as mycobacteria, Leishmania, actinomycetes, Nocardia ssp. or molds.

Section: Discussionmentioning

confidence: 99%

Indications and practical implementation of microbiologic diagnostics in patients with chronic wounds

Schwarzkopf¹,

Dissemond

2015

“…Various professional societies are working towards improving the evidence base for stage-adapted wound care [36]. Pain reduction is one of the requirements for wound dressings.…”

Section: Leg Ulcermentioning

confidence: 99%

Pain and pain management in dermatology

Beiteke¹,

Bigge

Reichenberger

et al. 2015

SummaryIt is estimated that 23 million Germans suffer from chronic pain. A recent survey has revealed that 30 % of chronic pain patients are dissatisfied with their pain management. Furthermore, five million Germans suffer from neuropathic pain, 20 % of whom are inadequately treated. Pain is also a symptom of many dermatologic diseases, which is mostly somatic and may be classified as mild in the majority of cases. Nevertheless, research on the quality of life (QoL) has increasingly shown a marked impairment of QoL by moderate pain such as in psoriatic arthritis. Severe pain is associated with herpes zoster (shingles), leg ulcers, and pyoderma gangrenosum. This article addresses the basics of pain classification and, in a short excerpt, pain transduction/transmission and modulation. The use of standardized diagnostic scales is recommended for the purpose of recording and monitoring pain intensity, which allows for the optimization of therapy and consistent interdisciplinary communication. Any dermatology residency program includes the acquisition of knowledge and skills in pain management. This review therefore aims to present fundamental therapeutic concepts based on the expanded WHO analgesic ladder, and describes a step-wise therapeutic approach and combination therapies. The article focuses on the pain management of the above-mentioned severely painful, conservatively treated dermatoses. Besides well-established therapeutic agents and current therapeutic standards, it discusses specific options based on guidelines (where available). Current knowledge on peri-and postoperative pain management is briefly outlined. This article addresses:  The fundamentals of the classification and neurophysiology of pain;  Standards for pain documentation in children and adults;  General standards for pharmaceutical pain management;  Current specific treatment options for postherpetic neuralgia, leg ulcers, and pyoderma gangrenosum in conjunction with the expanded WHO analgesic ladder.

“…Im Rahmen einer modernen, leitliniengerechten Behandlung von Patienten mit chronischen Wunden müssen auch mikrobiologische Aspekte berücksichtigt werden . Bei der Durchsicht der aktuellen Literatur wird allerdings deutlich, dass derzeit für die praktische Durchführung der bakteriologischen Diagnostik bei Patienten mit chronischen Wunden keine eindeutigen evidenzbasierten Empfehlungen ausgesprochen werden können.…”

Section: Diskussionunclassified

Indikation und praktische Durchführung mikrobiologischer Diagnostik bei Patienten mit chronischen Wunden

Schwarzkopf¹,

Dissemond²

2015