EUROPEAN  TISSUE  REPAIR  SOCIETY

Dr Leaper continues to investigate the prevention of post operative infection with innovative medical devices.

The effect of a radiant heat dressing in the management of patients with State III and IV pressure ulcers was published in the Journal of Wound Care, May 2000. P. Price, BA (Hons), PhD. CHPsychol, AFBPsS; S. Bale, BA, RGN, NDN, RHV, DipN; H. Crook, RGN, RCM; KG Harding, MB, MRCGP, FRCS, University of Wales College of Medicine, Cardiff, UK are the authors.

The use of heat in wound healing has been demonstrated in acute wounds to aid oxygen flow and hence aid healing. Despite randomization, patients receiving radiant heat therapy were more infirm than those receiving routine standard treatment (alginate dressings). This prospective, single centre, randomized trial resulted in an ac-celerated rate of healing for those receiving heat therapy compared to a standard treatment: time difference to 75% of original area 6.4 days (P = 0.057) to 50% of original area = 9.6 days (P = 0.039), time to 25% = 7.2 days (P = 0.01).

Four posters were presented at The 13th Annual Symposium on Advanced Wound Care and 10th Annual Medical Research Forum on Wound Repair in Dallas, Texas in April 2000 by clinicians investigating Warm-Up^® therapy.

Effects of an unheated warming bandage on skin temperature elevation and healing rate of full-thickness wounds Joseph E. Berman, PT, ATC; Luther C. KIoth, MS, PT, CWS; Marilyn J. Nett, MPT, Marquette University, WI; Sonia Dumit-Minkel, MD, PT; Carl H. Sutton, MD, VA Medical Center, Milwaukee, WI

The purpose of this study was to determine whether or not the dressing, without the heating element, raises skin temperature or facilitates healing. Warm-Up^® therapy was applied without its heating element to five full-thickness wounds for four weeks. Temperature immediately increased inside. Mean peak skin temperature increased from the baseline by 1.24°C within the dressing and by 1.29°C adjacent. These were less than the increases of 1.88°C and 1.86°C, that we have reported previously with the heating element. The wounds in this study underwent a reduction in mean length of 40.7% and in mean width of 33.3%. These wounds closed faster than the control wounds in our previous study (reduction in mean surface area of 24.66%) but not as quickly as the wounds treated with the heating protocol (reduction of 60.73%).

Evaluation of topical non-contact radiant-heat therapy for treatment of a non-healing pressure ulcer. Marilyn Diebold, RN, MSN, CS; Linda M. Eggmeyer, RN, BSN; David R. Thomas, MD, FACP, St Louis University, St Louis, MO.

This was an examination of a non-contact thermal wound treatment in a 72-year-old woman with a non-healing, Stage III, sacral pressure ulcer of greater than two months duration. The patient had multiple co-morbid conditions, reflected by a Functional Independence Measure score of 39 and Braden score of 13. Co-morbid medical conditions interfering with wound healing included diabetes mellitus, congestive cardiomyopathy, hemiparesis, renal failure, incontinence, and deep venous thrombosis. Despite an age-adjusted desired body weight 33% above normal, visceral protein stores were severely depleted (albumin 18 gm/deciliter). Photographic documentation shows dramatic re-epithelization in four weeks.

A randomized controlled trial using a heated dressing on full-thickness pressure ulcers. Luther C. KIoth, MS, PT, CWS; Joseph E. Berman, PT, ATC; Marilyn J. Nett, MPT, Marquette University, Milwaukee, WI; Sonia Dumit-Minkel, MD, PT June Warzel, RN, CETN, VA Medical Center, Milwaukee, WI

Studies have suggested that a system that administers heat at 38°C to chronic wounds through a sterile dressing is more effective than standard dressings. The wounds treated in this study with standard dressings underwent a decrease in mean length of 22.1%, from 2.71cm to 2.11cm; and a decrease in mean width of 23.5%, from 2.43cm to 1.86 cm. The heated wounds underwent a decrease in mean length of 49.5%, from 3.03cm. to 1.53cm; and a decrease in mean width of 45.8%, from 2.64cm to 1.43cm.

Increased fibroblast cell number and metabolic activity following pulsed radiant heating. George Cherry, Ph.D.; Zhidao Xia MD; Akio Sato MD; Margaret Hughes, PhD, Oxford Wound Healing Institute, Churchill Hospital, Oxford, England.

The authors demonstrated that the simple changing of wound dressings in patients leads to a significant decrease in wound temperature. This drop in temperature has been demonstrated to impair cellular metabolic activity of wounds. Non-contact radiant heat improves the healing of acute and chronic wounds. The aim of this study was to investigate the effect of pulsed heating on fibroblast growth and metabolism. Human dermal fibroblast cells were maintained in culture at 33.9°C and were pulsed heated using a radiant heat-producing clinical dressing with a designated temperature of 38.0°C. The results demonstrated that alter one week the number of cells in the radiant heat-treated group was significantly higher, 122% of that in the control group (P<0.003). Metabolic activity was 116% of that of the control cells (P<0.006). In summary, our in vitro findings demonstrated that controlled pulsed radiant heating used clinically increases the number and metabolic rate of fibroblasts.

A summary of the presentations at the Symposium on Thermoregulation in Wound Care which was held at St. Anne’s College and Green College at the University of Oxford, England from February 19–21, 1999 has been published by the Royal Society of Medicine Press; Limited International Congress and Symposium Series. Lectures were presented by 23 clinicians, scientists, and researchers on the role of thermoregulation in animal, in-vitro and human clinical studies of acute and chronic wounds. This publication was edited by Dr Terence F. Ryan, Dr Keith G. Harding, and Dr George W. Cherry.

As part of our commitment to clinical research, Augustine Medical’s Clinical Department awards two fellowship grants. During the year 2001, Dr Joanne Whitney from the University of Washington, USA, will study Warm-Up^® therapy on acute, elective abdominal wounds. Ms Sandra Lois Ellis, BS, RN, from Stockton-on-Tees, UK, will study the effect of local warming on the microbiology of chronic ulcers. In this study it is proposed to qualitatively measure the microbiology of chronic ulcers, of diabetic and pressure etiology, and correlate changes with healing progress, following periods of ulcer warming.

Additional articles on Warm-Up^® therapy can be found in Wound Repair and Regeneration, Ostomy/Wound Management, Journal of Vascular Nursing, Journal of Wound Care, Wounds, and the ETRS Bulletin.

Augustine Medical continues to support research with Warm-Up^® therapy on both chronic and acute wounds.