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AWMA & ANZBA Newsletter - December 2011
Contents
In this issue... Contents
| Guest editorial Paull G |
Page 188 | |
 |
Clinical observations supporting a vasodilatory effect of the modified
papaya extract OPAL001 Mitchell GK |
Page 190 |
|
Treatment of a sacral pressure ulcer and extensive hyperkeratosis with
OPAL A filtrate and cream: A case study Baldwin C & Bonham S |
Page 196 |
|
Effect of the novel wound healing agent, OPAL A on leukotriene
B4 production in human neutrophils and 5-lipoxygenase activity Russell FD, Windegger T, Hamilton KD & Cheetham NWH |
Page 200 |
|
The evidence and the rationale for the use of honey as a wound dressing Molan PC |
Page 204 |
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Sharp wound debridement in the management of recalcitrant,
locally infected chronic venous leg ulcers: A narrative review White W |
Page 222 |
|
Interdisciplinary chronic-wound care services involving
podiatry – a strengthened model of care? Butters T |
Page 229 |
| Book review | Page 235 | |
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Joanna Briggs Institute: Chemical debridement for venous leg ulcers | Page 237 |
| Journal watch | Page 238 | |
Clinical observations supporting a vasodilatory effect of the modified papaya extract OPAL001
Mitchell GK
Abstract
Vascular insufficiency is a major reason for the development and perpetuation of chronic wounds. It is plausible that agents that cause vasodilation may promote wound healing. The OPAL process is where ripened fruit is treated by homogenisation, heat treatment, alkalisation and filtration of the pulp. OPAL 001 uses papaw and peach fruits mixed 10: 1 by volume. This article presents four cases of non-healing ulcers that provide clinical observational support for the hypothesis that OPAL products facilitates healing by causing vasodilation of the blood vessels around the wound.
Treatment of a sacral pressure ulcer and extensive hyperkeratosis with OPAL A filtrate and cream: A case study
Baldwin C & Bonham S
Abstract
OPAL A, derived from the pawpaw fruit, is a promising treatment for chronic skin ulcers. We report the case of a 75-year-old man with paraplegia who presented with a chronic sacral pressure ulcer and extensive hyperkeratosis on his buttocks. After two weeks of treatment with OPAL A filtrate and cream and ongoing bed rest, the ulcer showed evidence of healing and there was a marked reduction in the hyperkeratotic coverage. Five weeks later, the condition of the ulcer was further improved, but the wound was not fully closed. The hyperkeratosis had disappeared. The patient was discharged and continued OPAL A treatment at home. Follow-up examination 24 days after discharge revealed the ulcer to be in good condition, with granulation tissue present on the surface of the ulcer. Hyperkeratosis remained absent and the skin surrounding the ulcer appeared healthy. Although further studies are clearly needed, the encouraging results in this patient contribute to the increasing evidence base justifying rigorous clinical trials of OPAL A for chronic skin ulcers.
Effect of the novel wound healing agent, OPAL A on leukotriene B4 production in human neutrophils and 5-lipoxygenase activity
Russell FD, Windegger T, Hamilton KD & Cheetham NWH
Abstract
OPAL A is a papaya pulp that is heated and alkalised with bicarbonate (the OPAL process) and is undergoing clinical trials for treatment of chronic wounds. The aim of this study was to investigate possible inhibitory effects of OPAL A and a non-alkalised papaya filtrate on the 5-lipoxygenase signalling pathway. Human isolated neutrophils were incubated with or without OPALA, non-alkalised papaya or sodium bicarbonate and then exposed to the calcium ionophore, ionomycin to stimulate leukotriene B4 (LTB4) production. The production of LTB4 was inhibited in a dose-dependent manner by all three treatments. The effect of these treatments on 5-lipoxygenase activity, the enzyme involved in the production of precursors of LTB4 was investigated using a cell-free assay. 5-Lipoxygenase activity was inhibited by OPAL A and non-alkalised papaya, but not bicarbonate. Column chromatography was used to show that the active components within OPAL A were non-proteinaceous polar compounds. The inhibitory effects of OPAL A and a non-alkalised papaya filtrate on 5-lipoxygenase activity and LTB4 production suggest a possible anti-inflammatory mode of action.
The evidence and the rationale for the use of honey as a wound dressing
Molan PC
Abstract
Although there are now several brands and types of honey wound-care products available as registered medical devices, there is little promotional advertising of honey products for wound care. The misconception that there is no evidence to support the use of honey, which seems to be quite common, may be due to this lack of advertising, and to the systematic reviews that have been published on honey concluding that the evidence is of low quality and/or there is a need for more evidence. However, the same lack of high-quality evidence exists with all the other options that clinicians have for dressing wounds. This places practitioners in a quandary. When clinical evidence of the highest level is not available, then decisions on modes of treatment need to be based on whatever evidence there is available. This review outlines the 16 randomised controlled trials (RCTs) of honey in wound care published since Molan reviewed the previous 17 in 2006, which bring the total of participants in the trials up from 1,965 to 3,556 and broadens the range of types of wounds on which trials with honey have been conducted. Another important factor influencing the choice by clinicians of which product to use on a wound is scientific rationale. This review covers the evidence and explanation of mode of action for various bioactivities in honey which aid wound healing: a very broad-spectrum antimicrobial activity that is effective on antibiotic-resistant strains; activation of autolytic debridement; anti-inflammatory activity; antioxidant activity; stimulation of growth of cells for tissue repair; and an osmotic action. The need for standardisation of these bioactivities is discussed.
Sharp wound debridement in the management of recalcitrant, locally infected chronic venous leg ulcers: A narrative review
White W
Abstract
Background: Sharp wound debridement has been identified as an essential component of biofilm-based wound care (BBWC) in the management of chronic wounds including chronic venous leg ulcers (CVLUs).
Aim: To evaluate the validity of available evidence regarding the role, safety and efficacy of sharp debridement in the management of recalcitrant, locally infected CVLUs.
Method: A literature search was conducted between August and September 2010. Evidence was sourced from the Cochrane Database of Systematic Reviews via Ovid, DARE, MEDLINE via OvidSP and CINAHL Plus. Search terms included "skin ulcer", "leg ulcer", "varicose ulcer", "wound pain", "wound infection", "biofilms", "debridement", "conservative sharp debridement". The search was restricted to adult, human subjects and articles published in English. The search was limited to articles published between 1999 and 2010.
Results: A Cochrane Systematic Review (protocol) was identified, with the review yet to be published on the effect of debridement on CVLU healing. Only three studies including a prospective, cohort study examining the effectiveness and feasibility of sharp debridement for CVLUs in the out-patient setting, a retrospective analysis of two randomised controlled trials (RCTs) examining the impact of serial sharp debridement on both CVLUs and diabetic foot ulcers (DFUs) and a report of four experimental models examining the effect of debridement on in vitro, in vivo and in situ (CVLUs) biofilms were identified.
Conclusion: Current high levels of evidence in the form of systematic reviews and large, well-designed RCTs are lacking at the time of this review. Ethical considerations in utilising RCTs to address clinical questions relating to debridement may have an impact on the design of future studies. Some low-level evidence exists, indicating sharp debridement may have an important role to play when undertaken as part of a multifaceted approach to the management of CVLU local infections (a biofilm), in combination with standard care. In this new and emerging science, it is proposed that a paradigm shift in current thinking will be required by both researchers and clinicians as urgently needed future research is planned and undertaken.
Interdisciplinary chronic-wound care services involving podiatry – a strengthened model of care?
Butters T
Abstract
Objective: The objective of this study was to determine preliminary outcomes for clients attending a chronic wound service with podiatry involvement as a core component in an interdisciplinary model of care and benchmark this data against other published chronic wound service outcomes with the same model of care.
Method: A journal search was completed to find any published research articles that were most similar in nature to our service model, with published rates of healing. The results of this published data were then compared to our healing rates.
Results: One comparison paper (Gohel, Taylor, Earnshaw et al. 2005) was identified. A comparison of the two models of care shows that both models of care have similar outcomes for our sample. The comparison study reported that 76% of clients were discharged healed at their standardised endpoint of 24 weeks. In comparison, the Craigieburn Chronic Wound Service reported in this paper had 72% of clients discharged healed with an average time to heal of 12.1 weeks over the sample period (July 2007 to October 2008).
Conclusion: Benchmarking against published data for a similar patient population, the Craigieburn Chronic Wound Service clinic population appears to have a comparable time to heal. However, additional comparative studies are needed to fully assess the effectiveness of the interdisciplinary model of care. This pilot data is an initial step to developing a formal study of the service model and to identify suitable services with which to prospectively benchmark overall healing rates and patient outcomes.
Chemical debridement for venous leg ulcers
The Wound Healing and Management Node Group
Question
What is the best available evidence regarding the use of chemical agents for debridement of venous leg ulcers?
Management of
Venous Leg Ulcers