Journal of Tissue Viability

Calendar of Events

2012-02-01

Reflections on a challenging year

Dan Bader — 2012-01-16

This year has included a number of dramatic events including the Middle East Spring, natural disasters in both New Zealand and Japan and the apparent fragility of world economies. By contrast my own experiences have been far less traumatic, although, over the last 11 months, the Editorial role has proved more difficult than I naively expected. There is no doubt that I would have sunk without trace by now, had it not been for the fantastic support I have received from the publishing team at Elsevier and the active Editorial Board of the Journal. To them I am continually grateful. Despite the trials and tribulations, I have enjoyed the challenge and continue to see the journal with affection and believe it to have a strong future. Over the last year I have managed to increase the pool of reviewers with various skills and expertise to accommodate manuscripts from a multidisciplinary range of disciplines. However it still remains a challenge to attract more manuscripts from the widest range of authors.

What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors

C. Gorecki, J. Nixon, A. Madill, J. Firth, J.M. Brown — 2011-12-02

Abstract: With the recognition of health-related quality of life (HRQL) as an important and relevant outcome in pressure ulceration, it is important to gain better understanding of the complex relationship among the various factors that affect it. A problem with existing literature in this area is that the impact of having a pressure ulcer on HRQL is combined conceptually with contributory factors which may influence outcome. This study identified contributory factors affecting pressure ulcer-related HRQL and explored interrelationships between factors based on views of adults with pressure ulcers. We obtained patient-reported qualitative data through semi-structured interviews with 30 patients with pressure ulcers recruited from hospital and community settings around England and Northern Ireland. Patients described how pressure ulcers affected their lives by recounting specific relevant events. Events (patient-reported issues) were sorted into categories and data framework analysed to produce a taxonomy of contributory factors. Inter-rater reliability established the extent of agreement between two independent raters. We identified 16 contributory factors, into two theme taxonomy: experience-of-care and individual-patient factors, defined by descriptive components. Our taxonomy is a comprehensive theoretical model of factors that contribute to pressure ulcer-related HRQL. We have also identified further research priorities to inform clinical practice.

The value of frozen section biopsy in diagnosing necrotizing fasciitis: Proposal of a new grading system

2011-11-21

Abstract: Goals and objectives: Necrotizing fasciitis is a serious disease entity, with only limited pathognomic features.Purpose: In necrotizing fasciitis a rapid diagnosis is necessary in order to reduce morbidity and mortality. In this study the investigation focused on specific features in the frozen section biopsy for diagnosing necrotizing fasciitis.Methods: A total of ten patients are described with final pathological examination of resected tissue.Results: A new grading system is suggested for frozen section biopsy in patients with necrotizing fasciitis. In the herein reported study it was found that granulocytes were present in both the frozen section biopsy and in the definitive paraffin coupes, in the subcutis and fascia layer.Conclusion: Frozen section biopsy could be useful in diagnosing necrotizing fasciitis.

Iterative design and testing of a hand-held, non-contact wound measurement device

Stephen Sprigle, Michelle Nemeth, Anita Gajjala — 2011-09-26

Abstract: A variety of wound measurement techniques are available to clinicians. Options range from relatively simple and inexpensive to complex, expensive devices.An iterative design approach was used to evaluate and improve performance and clinical utility of a new wound measurement device (WMD). The design was based upon a commercially available Smartphone. Accuracy was assessed using bench testing and reliability of area measurements was determined using multiple evaluators. Clinical utility was investigated by deploying the WMD during wound rounds in a rehabilitation hospital.Accuracy testing revealed an average error <2% at 0° or skew and an average error of 4.28% at 10° of skew. The intra-rater reliability exceeded 0.975 for all raters and inter-rater reliability was 0.966. Clinical utility testing provided the opportunity to address several usability concerns including the software interface and computation times.The accuracy and reliability of a new, non-contact wound measurement device exceeded that of other manual techniques and were, at least, equivocal to other computer-based technologies. Some limitations of using a Smartphone were identified by the clinicians that can be addressed by the more advanced processing power of newer technology. Overall, the WMD was shown to have the potential as a useful clinical tool.

A simple stochastic model to explain the sigmoid nature of the strain-time cellular tolerance curve

Efrat Leopold, Amit Gefen — 2011-12-15

Abstract: Using animal and tissue-engineered experimental models, we previously found that a decreasing sigmoidal function is adequate for describing the diminishing tolerance of skeletal muscle tissue/cells for static mechanical strains delivered over time. Compressive loads at the tissue scale, which are associated with weight-bearing, appear to stretch the plasma membrane (PM) of cells at the mesoscopic–microscopic scales. The permeability of such stretched PMs may then increase, which could alter the control mechanisms and consequently the homeostasis of the deformed cells. The present paper is aimed at demonstrating this suggested deformation–diffusion damage pathway – which is particularly relevant to the aetiology of deep tissue injury – at the level of a single cell, using simple stochastic computer modeling which is supported by experimental confocal microscopy imaging data. The modeling and confocal studies better explain the strain-time injury threshold previously proposed by our group, and in particular, they provide an explanation for the nature of the rapid decrease of the threshold curve. The simulations revealed that there was a clear trend of nearly inverse relationship between the level of stretch applied to the PM and the time for accumulation of cytotoxic contents of a diffusing biomolecule. Taken together with the confocal data, which correspondingly demonstrated increased permeability of the PM of statically stretched cells to a fluorescent dye, the present results point to cell-level deformation–diffusion damage as a factor that should be looked at more closely in aetiological research of pressure ulcers.

Protracted wound healing due to pro-inflammatory condition: An instance of antagonistic pleiotropy theory

Fatemeh Momen-Heravi — 2011-11-03

Inflammation, triggered by hazardous stimuli and agents like infection and tissue injury, is defined as a wide variety of adaptive physiological and pathological processes to avoid infection and repair damage, returning the organism to the normal state of homeostasis. It is well established that edema and inflammation can lead to a painful and delayed healing course. In addition, although inflammatory cells are intimately involved in the regulation and progression of normal adult wound healing, multiple lines of evidence suggest that reduction of one or more of the inflammatory cell types can actually have a positive outcome on the closure of wounds .