Cover Page, Contents and Abstracts
The current cover page of the latest issue of the Journal is found here along with the contents and abstracts of the articles contained within the current issue of the journal.
Volume: 17 |
Issue: 2 |
Release: May 2009
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Electronic articles from the current and last 3 issues of the Journal are only available to AWMA Members and Wound Practice and Research subscribers. Click on the pdf icon next to the title to access the article
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Contents
In this issue...
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Editorial: We are small, we are rare but we do count!
Fitzpatrick M |
Page 60 |
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Epidermolysis bullosa (EB) – diagnosis and therapy
McMillan JR, Long HA, Akiyama M, Shimizu H & Kimble RM |
Page 62 |
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Management of epidermolysis bullosa (EB) skin lesions with a non-adherent dressing, Urgotul®
Stevens LJ |
Page 71 |
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Raising the roof on epidermolysis bullosa (EB): a focus on new therapies
Kopecki Z, Murrell DF & Cowin AJ |
Page 75 |
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Comparison of the two leading approaches to attending wound care dressings
Gillespie BM & Fenwick C |
Page 84 |
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Nutrition therapy in the prevention and treatment of pressure ulcers
Crowe T & Brockbank C |
Page 90 |
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Book review |
Page 100 |
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Journal Watch
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Page 104 |
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Product News
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Page 105 |
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AWMA directory |
Page 106 |
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Abstracts
Epidermolysis bullosa (EB) – diagnosis and therapy
McMillan JR, Long HA, Akiyama M, Shimizu H & Kimble RM
Abstract
The hemidesmosome (HD)-anchoring filament complex comprises a multiprotein complex that aids the attachment of epidermal keratinocytes to the underlying basal lamina and dermis. The importance of the HD and its components is highlighted by genetic defects that cause congenital blistering skin diseases that are categorised under the epidermolysis bullosa (EB) group of disorders. EB disorders can be subcategorised into three main subtypes by the level of epidermal separation – within the basal keratinocyte (EB simplex – EBS), between the keratinocyte and underlying basal lamina (junctional EB – JEB), and separation beneath the basal lamina (dystrophic EB – DEB). HD-anchoring filament-related components – including keratins 5 and 14, plectin, a6ß4 integrin, collagen XVII, laminin 332 and collagen VII – have been demonstrated to harbour defects leading to EB disease. We summarise here the current understanding of the biological function of these HD-components and their involvement in EB in light of their functions in keratinocyte adhesion and also describe putative future therapeutic avenues that hold promise to alleviate the morbidity suffered by EB patients over the coming decades.
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Management of epidermolysis bullosa (EB) skin lesions with a non-adherent dressing, Urgotul®
Stevens LJ
Abstract
Epidermolysis bullosa (EB) is defined as a rare group of inherited skin disorders involving blistering of the skin and sometimes mucous membranes. It is characterised by recurrent, chronic and painful skin lesions. The local management of lesions attempts to reduce the frequency of skin breakdown, reduce the size of the chronic wounds and minimalise pain. This requires a nonadhesive and non-adherent dressing to prevent pain and bleeding on removal.
The aim of this small case study was to assess the efficacy of the primary dressing Urgotul® in two patients suffering from non-Herlitz EB. The treatment was initiated on a primary visit by the clinical nurse consultant, and was then monitored for a maximum of 8 weeks. Assessment was based on the level of pain associated with the dressing change, ease of applying and removing the dressing, bleeding, trauma, adherence of the dressing to the wound and the effect on wound healing. The findings show that Urgotul® is an effective primary dressing for the treatment of EB wounds, demonstrating pain free removal and improved wound healing.
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Raising the roof on epidermolysis bullosa (EB): a focus on new therapies
Kopecki Z, Murrell DF & Cowin AJ
Abstract
Epidermolysis bullosa (EB) is a complex group of genetic disorders producing various degrees of recurrent skin blistering and epidermal detachment from the basement membrane. Patients with this disease experience the loss of intact epidermis, disruptions of basement membrane adhesion units and altered cellular adhesion, migration and integrin expression. Wound healing in patients suffering from EB remains a major challenge to their survival because of infection risk and fluid loss.
There are four main types of EB each characterised by different levels of blistering formation at the dermal-epidermal junction (DEJ) (basal layer, lamina lucida, sub-lamina densa and various respectively) and different clinical phenotypes. Advances in the understanding of the pathogenesis of EB in the last 15 years have led to the identification of several candidate genes and proteins; however, present management of these diseases is still supportive and therapy symptomatic. Different avenues of therapy options being investigated, some of which are in clinical trials, include bone marrow transplant, gene therapy, cell-based therapy and protein-based therapy. Further research focused on the development of novel therapies may lead to improved quality of life for patients suffering from EB.
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Comparison of the two leading approaches to attending wound care dressings
Gillespie BM & Fenwick C
Abstract
Many nurses practise wound dressing based upon knowledge of sequential procedural steps rather than understanding the principles underpinning the most effective approaches to wound dressing. Currently two leading dressing approaches, aseptic (clean hand/dirty hand) technique and wound field, are being taught to undergraduate nursing students. Collectively and comparatively, both techniques have evoked some controversy regarding the most appropriate and effective technique to apply. This paper clarifies the differences between these approaches and suggests that both techniques will have similar outcomes providing the principles of minimising or eliminating risks associated with contamination are practised.
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Nutrition therapy in the prevention and treatment of pressure ulcers
Crowe T & Brockbank C
Abstract
Pressure ulcers are serious problems within hospital and aged care settings and are associated with adverse health outcomes and high treatment costs. Because of a high incidence of pressure ulcers in the health system, attention is now being directed to not just preventing, but also more effectively treating them. Nutrition plays a fundamental part in wound healing, with malnutrition, dehydration and recent weight loss identified as independent risk factors for the development of pressure ulcers. While the optimal nutrient intake to promote wound healing is unknown, increased needs for energy, protein, zinc and vitamins A, C and E have been documented. There is reasonable evidence to show that nutritional support, mostly by high-protein oral nutritional supplements, is effective in significantly reducing the incidence of pressure ulcers in at-risk patients by 25%. Intervention studies using high-protein or specialised disease-specific nutritional supplements support a trend to increased healing of established pressure ulcers. Such specialised supplements are typically based on defined amounts of arginine, vitamin C and zinc. Mechanisms by which nutritional support can aid in pressure ulcer prevention and healing are likely related to addressing macro- and/or micro-nutrient deficiencies arising from either poor oral intake or increased nutrient requirements related to the wound healing process. With much more research still to be done in this area, nutrition support appears an efficacious and costeffective adjunct to current medical and nursing approaches in the prevention and treatment of pressure ulcers.
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Last Updated : 4 June 2009
