09.05.2015

Traditional wound treatment guidelines

This short paper reports on the successful treatment of a teenage patient with a pilonidal sinus.
The traditional treatment of a pilonidal sinus involves wound healing by secondary intention, since primary wound closure is considered to be prone to postoperative complications and leads to frequent recurrence of the problem. In the majority of cases, this procedure is performed as an inpatient treatment with multiple major daily dressing changes for the hospital staff and a considerable number of days off school or work for the individual patient. A 15-year-old boy presented with an ongoing fistulating pilonidal sinus in his ano-genital region, which had been present for approximately 18 months. After staining with methylen blue, the fistula network was excised under general anaesthesia (see Figure 1 and Figure 2). The patient was treated as an inpatient for the initial operation and at the point when the exudate, slough and debris were removed because these two procedures were performed under general anaesthesia. The patients have been in favour of the rapid return home the therapy enabled [4] [10] [12] [13], while the carers found the interdisciplinary team approach led to more effective and efficient care [2] [4] [5] [9] [13]. The German social law statute book states ‘that any health insurance has to provide adequate, useful and economic care only and that care providers are not allowed to provide any unnecessary or uneconomic care to their patients’ [16].
SeptiCure® Burn Dressings will move debris to the wound surface, and in the case of 3rd degree burns will form a black scab, which can be surgically removed to enhance debridement of burns. By using SeptiCure less damage will occur to healthy tissue, tendons, veins and nerve endings. Allow SeptiCure® Burn Dressings to deslough the wound and to perform natural healing without scars.
The adsorption capacity of SeptiCure® Burn Dressings will promote blood circulation to the wound area is promoted, so increasing the process of Natural Healing. Prescribe Durmo Spray for the treatment of maturation stages, after burn treatment, to prevent scars. SeptiCure® Burn Dressings moved debri to wound surface where it can be removed surgically. To remove the previous traditional dressing, and to lessen pain, spray with CoolBurn Spray. DonorAid dressing recommended after desloughing as children granulate much quicker this will help to prevent over granulation. The Woundhub II can spray creams as thick as honey to water based solutions, at the choice of the practitioner.
The system produces a fine jet of air and ozonated water or saline, at the desired pressure, to remove damaged and necrotic tissue, by agitating the tissue off the wound.
The debrider has an adjustable oscillator on both the air and water line that can be adjusted to obtain a variety of "jack-hammer" settings.
In many cases this will avoid the need for sharp debridement, anaesthesia and theatre admission.
This is a great boon for rural clinics where access to theatre facilities is often difficult. While maintaining a moist wound bed it is nevertheless important to remove excess moisture from the wound, to allow speedy application of topical creams and bandages. Wonder-med uses pure air that has been warmed to the desired temperature to gently blow excess moisture off the wound. This facility is very useful where large wounds have been cooled during the irrigation process. Massage stimulates blood flow through skin tissue, by the dilation of micro vessels and the reduction of oedema. The application of intermittent positive pressure has been shown to encourage blood to flow to wound areas that may be starved of oxygen, as often is the case with diabetic foot ulcers and other peripheral vascular conditions. The treatment improves circulation and blood flow and reduces oedema, especially useful for post mastectomy and other conditions of lymph damage.
Provides all the traditional benefits associated with massage for sports and other injuries. The same system can be used for assisting in removing dressings adhering to the wound through strike-through bleeding or scab formation, without disrupting the epidermal border. Because the ozonated, radical water has the ability to oxidize germs, the water has a superior cleaning ability to conventional saline and is much cheaper, being manufactured on site at a fraction of the cost of saline. The wonder-med Ozonating system consists of a high voltage electrical ozonator through which pure medical oxygen is passed at a controlled flow-rate. Our Knowledge Base includes videos of WoundHub II in action as well as articles about it's use.
In addition to traditional therapies, Kessler Institute for Rehabilitation patients participate in a variety of specialized programs.
The facility’s interdisciplinary stroke team works closely throughout the continuum of care to deliver a seamless rehabilitation program. The stroke team at each of Kessler’s three hospital campuses also works together to orient patients and their families to the rehabilitation setting. Like many rehabilitation hospitals, the approach at Kessler is to begin preparing for a patient’s discharge upon admission. Compassion, collaboration, and communication also drive the delivery of patient-centered care. In addition to traditional therapies, Kessler patients participate in a variety of specialized programs that foster greater independence, such as medication management, meal management, and community life skills, all of which offer opportunities to develop skills with others experiencing the same or similar challenges. Constraint Induced Movement Therapy (CIMT) is an excellent example of evidence-based practice at work.
The scope of high-tech devices and equipment available for stroke rehab provides therapists with important options in how they approach the varied rehabilitation needs of stroke survivors. Kessler embraces a “high-touch, high-tech” approach to treatment, which calls for the use of a wide range of leading-edge technologies to complement traditional therapies.
Robotics—One stroke rehab technology the facility uses is a robotic device that works in three dimensions to help patients with absent-to-emerging upper-extremity movement.
Exoskeletons—For upper-extremity needs, the facility uses an exoskeleton with integrated springs that embraces the arm from the shoulder to the hand, and counterbalances the weight to enhance function and neuromuscular control. Electrical Stimulation—Clinicians may choose to use an upper-extremity orthosis or lower-extremity orthosis built to provide functional electrical stimulation (FES).
Virtual Reality—Through the use of a popular consumer-level gaming platform and other computer-based technologies, therapists are able to target a range of motor, visual, perceptual, and cognitive issues, and can even incorporate balance training.
Body Weight Supported Training—BWST allows safe gait training to be initiated early in the rehabilitation stay while the patient’s body weight is supported through a harness system. Electronic Aids to Daily Living—In addition to devices that assist with daily activities, there are an increasing number of apps that monitor health, provide reminders such as when to take medications or schedule follow-up appointments, and in general help to make life ahead easier. Although walking is a primary goal for most stroke survivors, some will require a wheelchair. The stroke teams at Kessler Institute’s three campuses have a unique opportunity to work directly with the research scientists at Kessler Foundation, a collaboration that facilitates learning across both organizations. Most recently, for example, a Neglect Assessment Protocol and a Prism Adaptation Protocol for the treatment of spatial neglect in stroke patients were adopted. Extensive education and training is provided by facility staff to patients and their families as a way to prepare them all for the rehabilitation experience and their lives moving forward. Upon discharge, most stroke survivors will continue their rehabilitation to build on the gains they have made.
Gretchen March, OTR, uses an upper-extremity orthosis to provide functional electrical stimulation. The stroke team at Kessler Institute for Rehabilitation guides stroke survivors and their families through the often complex challenges they face, with the aim of helping them understand their condition, manage goals and expectations, and prepare for what is typically described as a “new normal.” Through specialized treatment, advanced technologies, technology, education, training, and support, patients are able to optimize functional outcomes and reclaim their independence. Gretchen March, OTR, is an Advanced Clinical Specialist with an expertise in neurological rehabilitation. Lorraine Fuentes, PT, graduated with a BS in physical therapy from The University of New England and currently works as an advanced clinical specialist at Kessler Institute for Rehabilitation in Saddle Brook, NJ, on the stroke unit. Danielle Weiser, PT, DPT, NCS, earned a Doctorate in Physical Therapy from Thomas Jefferson University.


Eileen Yorke, OT, ATP, SMS, is an occupational therapist who has been practicing for more than 20 years in various settings, including acute rehab and early intervention.
We have long recognized that DFUs are frequently the result of high pressures causing injury to the skin envelope of neuropathic (or ischemic) individuals. Because of the aforementioned impediments (real or perceived) to the routine use of the TCC, alternative devices have been used for many years. As might be anticipated, when directly comparing healing rates between removable and irremovable RCWs, the latter iTCC devices were more effective because they also removed patient non-adherence from the offloading prescription. Healing sandals, modified surgical shoes, or insole modifications in patients’ shoes are no longer considered adequate pressure relieving interventions for plantar foot ulcers (although for non-plantar wounds such therapies might be sufficient). Mueller MJ, Diamond JE, Sinacore DR, Delitto A, Blair VP, 3rd, Drury DA and Rose SJ: Total contact casting in treatment of diabetic plantar ulcers. The Mayer Institute specializes in delivering world-class, evidence-based diabetic foot wound care and education. Physicians are beginning to use a novel therapy for treating aneurysms: the use of a platinum coil, which is threaded to the site of concern and seals off the potential rupture. Over 95% of aneuryms not located in the brain are caused by atherosclerosis, the hardening of the blood vessels. To confirm an aneunysm, a doctor will perform either an CT scan with IV contrast (most commonly) or MRI scan to get a clear picture of the location and size of the aneurysm. Aneurysm rupture is a serious surgical emergency, with survival at about 50% with traditional surgical methods. First, small hole is made near the groin and a flexible tube is threaded towards the site of the ruptured aneurysm. What I love about shit like this is imagining the thought process that went into this preceding the action of what is essentially a novel approach. But it certainly applies to primitive technologies when there weren’t many adaptable applications around.
I’m getting ahead of myself, and far too wordy, since all I wanted to was express my enjoyment over reading such discoveries.
Retrospectacle has been a wonderful hobby and outlet for my writing for almost three years.
In addition, personal hygiene may be difficult for a patient to maintain and participation in sports and social activities may be a problem during healing.
The area was producing a continuous, offensive exudate that had caused him to withdraw from all sports and was affecting his school and social life.
During the next dressing change, four days later, more slough was removed (see Figure 5 and Figure 6).
All other dressing changes were carried out without anaesthesia on a day-surgery basis, thus avoiding a long hospital stay, the costs this would involve and the impact on the patient’s quality of life. The amount of time spent as an inpatient can be substantially reduced as shown in this case. The authors undertook a prospective, open and uncontrolled multicentre study, using the short version of the validated Freiburg Life Quality Assessment patient questionnaire.
The intermittent positive-pressure of the water supply can be used with different degrees of aggression, depending upon the requirements for specific wounds.
It is a major advance on conventional treatments, especially with child burn victims where treatment times are critical. The broad, flat nozzle provides a high volume of air, warmed to the desired temperature, applied with imperceptible impact pressure. The treatment assists in preventing bedsores, reduces neuropathy and accelerates the healing of diabetic ulcers and similar wounds.
The application of a fine spray of wet air onto the wound has a local anaesthetizing effect, particularly important with child burn victims.
The gas is then bubbled through a sealed stainless steel container for a pre-determined length of time. Unstable ozone electrons attack the cell walls of bacteria, viruses, yeast and abnormal tissue, rupturing them and destroying them by inactivating the cell enzymes. Music therapy, for example, can provide meaningful physical and emotional recovery after stroke. At Kessler Institute for Rehabilitation, a multidisciplinary team of stroke specialists provides the integrated care and treatment to help each patient regain the strength, skills, and strategies to resume life to its fullest. This process begins with the initial assessment during which clinical staff evaluate the patient’s medical, physical, and cognitive levels as well as their personal goals and expectations. This includes everything from discussing how to use the calls, bells, and televisions to understanding their daily schedules to being made aware of various hospital policies and services. The goal is to enable every patient to return home, or in some cases, to best prepare him or her for the next appropriate level of care. Like many rehabilitation hospitals, the approach at Kessler Institute for Rehabilitation is to begin preparing for a patient’s discharge upon admission.
Physicians, nurses, therapists, and other team members of this facility work closely to ensure that hands-on care and advanced technologies balance to meet the needs—and the changing needs—of each patient to help optimize recovery. Another unique program is Canine Companions for Independence, through which individuals work with one of the facility’s specially trained dogs to perform various therapeutic tasks. Stroke survivors often express frustration that they are unable to move an arm or leg, and give up. What these technologies have in common, however, is that they are effective in promoting recovery and improving a patient’s strength, skills, and independence. The therapy staff receives comprehensive education and training about the use of this advanced equipment to ensure it is being employed correctly and safely with appropriate patients. Training may be entirely passive, or may require the patient to initiate the movement pattern with robotic assist, and may progress to having the patient complete the movement without robotic assistance. What patients report they enjoy most about this technology is that it is an interactive system that uses a gaming-type format for directing movement and providing feedback.
Both devices use a wireless form of neuromuscular electrical stimulation to activate weak muscles and facilitate movement, and may improve foot drop. Units can be used over a treadmill or over ground, depending on the individual’s needs and progress. At weekly neuro rounds, for example, a case study is presented to offer insight into how research is being translated into clinical practice. It is reported that up to one-third of all stroke patients experience some form of neglect, but often that neglect is neither recognized nor reported.
This is a collaborative effort that begins prior to admission when Kessler’s hospital liaisons first meet with the individual, and continues long after discharge with support groups and follow-up care, including outpatient services. Individuals can benefit from an array of outpatient services, including Kessler’s cognitive rehabilitation, driver rehabilitation, and step-down programs. Input gathered from family meetings, focus groups, satisfaction surveys, and other channels enables the team to continually identify opportunities for quality improvement and ways to further enhance the rehabilitation experience at Kessler Institute. The device is an advanced rehab technology often used among stroke patients to activate weak muscles and facilitate movement. She has developed and implemented CIMT protocols for Kessler Institute for more than 30 years bringing evidence based practice into the clinical setting.
She practices at Kessler Institute for Rehabilitation in Saddle Brook, NJ, as a clinical specialist treating patients with neurologic conditions in the inpatient setting. She specializes in the area of wheelchair seating and positioning, and has earned her ATP and SMS certifications. For plantar ulcers, of course, this comes from walking in improperly fitted shoes or in footwear without sufficient protection for the sole of the foot.
The problem with these devices, as in most alternative devices, is that they are indeed removable and patients prefer to walk without them- especially at home.
Finally, several authors have compared efficacy of non-removable cast walkers with TCC and found essentially equal healing rates between the two types of devices.
It describes a local dilation (ballooning or distortion) of a blood vessel, which is usually cause by a build up in pressure due to blockage.


Traditionally, the aneurysm could be either resected (removed) through elective surgical repair, and replaced with a synthetic conduit, or a graft of another vessel could be used to replace the damaged one. But now, as reported in BBC News and published in The Lancet, a new treatment involving platinum coils may increase survival rates. Next, the platinum coils are pushed into the aneurysm itself, providing it with structural support.
The advantages of changing German healthcare policy to allow this therapy to be used in outpatient and home-based care settings is also discussed.
The area subsequently becomes infected, which may lead to abscess formation with a proximal and presacral extension. Granulation tissue may take several weeks to appear and time to healing may be lengthy [1] [2] [7].
The area had previously been treated by performing a daily wash-out of the wound during showering and the application of a diluted iodine solution (Betadine) and dry gauze dressings. Former leakage problems, especially around the anus or an artificial anus, have been solved by new gluing techniques, allowing patients to take showers again and resume a social life [6] [8].
Discussing the relationship between quality care and cost-effective care in Swiss pediatric wound care. The system can deliver a range of topical creams, applied according to the required coverage or thickness in a fraction of the time normally required. Because stroke survivors and their families often initially have many questions, concerns, and fears, it is the responsibility of the team members to address those considerations with the aim of minimizing any fears. With this in mind, the team communicates daily and holds weekly team conferences to monitor the patient’s progress, identify any barriers to discharge, and brainstorm ideas and options to promote a safe discharge to home.
The goal is to enable every patient to return home, or in some cases, to best prepare that person for the next appropriate level of care.
Patients often demonstrate improved participation in therapy sessions when working with their therapist and the facility dog. Using CIMT, the therapist “forces” the patient to use the affected limb by restricting use of the unaffected arm or leg. Similarly, for lower-extremity needs, patients may be introduced to other exoskeletal devices to help improve mobility and gait. Electrical stimulation technology is also used to treat swallowing disorders common among stroke survivors. Specially trained physical therapists facilitate weight shift and limb advancement for optimal gait mechanics. Both basic and high-tech models are available to maximize comfort, postural alignments, and pressure redistribution to prevent skin breakdown.
Working with Kessler Foundation, the stroke team has been educated and trained on the Kessler Foundation Neglect Assessment Protocol (KF-NAP), which is now a required screening tool for all stroke patients at Kessler Institute. Throughout the stay, patients also learn to how to best manage their condition, deal with any emotional challenges, and adapt to any changes that they face. The effectiveness of these programs that has been observed is due in part to the continuity of care, communication, and collaboration between Kessler’s inpatient and outpatient stroke specialists. March is involved in using technology as an adjunct to traditional therapies for upper extremity motor control with excellent outcomes. She holds an American Board of Physical Therapy Specialties certification in Neurologic Physical Therapy and is a member of the APTA, NJ chapter. The clinician simply needs to perform a systematic and thorough evaluation of each and every ulcer to be able to determine important underlying characteristics and perturbations that can impair normal healing. From these studies, we now recognize the superiority of nonremovable devices for offloading DFUs and generally recommend this approach for the management of the majority of plantar DFUs when TCC is not used as a first line offloading therapy. When this pressure builds up, the wall of the blood vessel is progressively weakened and the liklihood of bursting increases. The method, which involves making a tiny puncture wound and threading the metal coil through blood vessels, was tested in 2002 but stopped because the results were so positive.
Better fixation around this sensitive and critical area improves patient comfort and care by reducing the risk of unwanted leakage of stool or discharge from the wound and the resulting malodour. The use of single-case decisions, based on the evaluation of individual treatment needs, seems inappropriate [14].
Therapie aus Patientensicht: Multicenterstudie mit Patientenrelevanten Endpunkten [Patient evaluation of the benefit of outpatient and inpatient vacuum therapy. The ozonated water is sucked from the container into the air stream for use as either a debriding liquid or irrigating solution. Both ozone and hydrogen peroxide are oxidizing agents, but only ozone releases free electrons.
This is done by providing knowledge and understanding to the patient and the patient’s stakeholders. When even the slightest trace movement is recognized, the patient is encouraged and, in fact, the impact on an individual’s attitude can be extraordinary.
It is used to help identify patients with visual special neglect in three areas: personal, peri-personal, and extra-personal space. The “Steps for Wellness” program, for example, emphasizes the lifestyle changes that can help to minimize the risk for recurrent stroke. Nonetheless, the aforementioned Cochrane review supports the important benefits and efficacy of the TCC. Aneurysms often occur in the aorta (the heart’s major artery) and in the brain at the Circle of Willis (ring of arteries at the base of the brain). A lack of stringent personal hygiene and microtrauma can increase the likelihood of abscess formation and fistulae [1].
The hallmark of this program is the level of teamwork that, when combined with evidence-based treatment and leading-edge technologies, supports stronger patient outcomes. Team members associated with the patient’s case share information provided by the patient and family to form a more complete and accurate picture of the individual and any family circumstances that might impact recovery. While high numbers of repetitions in the context of an actual task is needed, patients are also required to practice movement patterns outside of therapy sessions to maintain motivation and gain greater self-sufficiency. Because patients with neglect may require additional time to recover their skills, the KF-NAP has helped the team to better plan for discharge.
Also, family members are provided with the information and training they need to support and care for the survivor, as well as guidance about any home modifications or equipment that may help in the transition to home.
When severe, an aneurysm can result in loss of blood flow to a organ, leading to brain damage or death. Blood then clots around the coils in the coil-filled aneurysm, preventing further bleeding and bursting.
On the third dressing change the patient reported having experienced a sudden leakage of increased exudate, and slough and debris were detected on the wound surface (see Figure 4).
This helps to ensure that what clinical staff learns from the patient and that person’s family is complete and consistent. Similarly, prism awareness training has proven effective in treating some types of neglect and in helping patients achieve better outcomes.
In addition, an atherosclerotic plaque (fatty cholesterol deposit) can efficiently plug a vessel, increasing pressure.
Based on this profile, the teams works with the patient to establish realistic goals and collaborate on establishing the most appropriate treatment plan. Aneunysms can induce blot clots as well, increasing the chances of an embolism (a clot which can travel to another part of the body, causing damage).



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