Wound Healing Southern Africa

A case series of toxic shock syndrome in a low-middle-income country burn service: creating awareness about the lesser known and potentially lethal complication

C Rajchrt — 2023-06-30

Introduction: Toxic shock syndrome (TSS) is a bacterial exotoxin-mediated disease that can be a complication of thermal injury in paediatric patients. This disease is acute in onset, occurring mostly within the first 48 hours after thermal injury, and it progresses rapidly to shock and death if appropriate management is not instituted. This case series describes the clinical diagnosis, course of management and outcome of TSS in a single institution in KwaZulu-Natal to highlight the condition in our setting and create awareness.

Methods: The burn admission database was retrospectively searched for patients with a diagnosis of TSS between January and December 2022. Demographic, injury, laboratory and outcome data were collected.

Results: Four out of 106 paediatric admissions were managed for TSS. The average age was 23 months, with 3 out of 4 children being female. The mechanism was hot water scald in all cases, with percentage total surface area burns between 15% and 30%. All patients survived, with one admission to intensive care and one patient developed acute kidney injury, which resolved by the time of discharge.

Conclusion: Our series demonstrates the typical presentation and laboratory features described in the literature. TSS is a lesser-known complication of burn injuries in young children with a high mortality rate if the diagnosis is missed. Awareness of toxic shock as a diagnosis in a child whose condition deteriorates within the first 48 hours of injury, combined with a treatment protocol, can effectively reduce morbidity and mortality.

Pyoderma gangrenosum – three fulminant cases and a review of treatment

C Wittstock — 2023-06-30

Pyoderma gangrenosum (PG) is a rare, chronic, ulcerative skin disorder. It typically presents with a painful nodule or pustule which breaks downs to form a progressively enlarging ulcer.¹ It may present after apparently minor trauma or complicated surgical treatments. We present three aggressive cases of PG and their management.

Minimum infection prevention and control requirements for independent wound management facilities: a measured approach

H Leach — 2023-06-30

In the independent wound management facility (IWMF) environment, infection prevention and control (IPC) practice is seldom measured and recorded. Furthermore, no standardised IPC recommendations are available for the IWMF in South Africa. No baseline data is available on current infection control practices in preventing healthcare-associated infection (HAI) and antimicrobial resistance in wound management facilities. This raises two important questions: Firstly, are IWMFs adhering to national and international IPC requirements to provide protection and safety to patients, health care providers and visitors? Secondly, what should the minimum requirements of IPC core components look like in the IWMF?

Return patients living with chronic wounds to healing sooner

E Galea — 2023-06-30

Technology Lipido-Colloid with nano-oligosaccharide factor (TLCNOSF) range’s efficacy in healing significantly sooner has been demonstrated in the highest level of clinical studies (double-blind, randomised controlled trials)^1,2 and through observational studies.³ These studies have also demonstrated that the earlier the TLC-NOSF (UrgoStart) treatment range is initiated, the more effective it is for complex and first-intention wounds.^2,3

CPD Questionnaire (V16N01)

Editorial Office — 2023-06-30

CPD Questionnaire

Secondary closure of open sternal wound using mechanical creep and negative pressure wound therapy in an outpatient setting – a case report

ZR Van der Merwe — 2023-06-30

This case report demonstrates the secondary closure of an open sternal wound using mechanical creep and negative pressure wound therapy (NPWT) in an outpatient setting, focusing on the decrease of wound healing time and cost of treatment. An understanding of the relationship between the prevention and treatment of surgical site infections (SSIs) is discussed. Furthermore, the importance of a multidisciplinary team (MDT) approach involving a cardiothoracic surgeon, wound care nurse, and dietitian to achieving wound healing using mechanical creep, NPWT and good wound management is demonstrated. In this patient, the mechanical creep technique using TopClosure^® and NPWT proved to be effective and led to a 60% decrease in wound size by week 4, and complete wound closure by week 9.

Use of activated charcoal combined with silver for diabetic foot ulcer

YM Choonara — 2023-06-30

Most wounds heal by primary intention, in which the edges of the incision are brought together using sutures, staples, or clips. However, certain wounds may be left open to heal (if there is a risk of infection or there has been considerable tissue loss). These wounds are known as wounds healing by secondary intention. The secondary intention approach is a time-honoured practice with a solid track record. It is sometimes neglected as a good option to urgent repair of wounds, which is unfortunate given the proliferation of many reconstructive procedures that have emerged in recent decades. In certain instances, the aesthetic and functional outcomes of secondary intention healing are on par with those of more difficult reconstructive surgical procedures. This case demonstrates the efficacy of wound closure achieved by secondary intention with the use of activated charcoal combined with silver, which led to extraordinary results.

The use of intralesional recombinant human epidermal growth factor (rhEGF) in advanced diabetic foot ulcers in South Africa

TG Mothabeng — 2023-06-30

Treatment of complex diabetic foot ulcers (DFU) with intra- and perilesional injection of recombinant human epidermal growth factor (rhEGF) has been safe and effective in clinical trials. Here, we report results on the efficacy and safety of this treatment in South Africa.

Human amniotic membrane accelerates healing in a hard-to-heal diabetic foot ulcer

PJ Idensohn — 2023-06-30

Human amniotic membrane (HAM) is acquired from the human placenta. This advanced regenerative therapy rich in growth factors, stem cells and cytokines, limits the extent of continuing inflammatory damage, decreases the microbial bioburden, and promotes progression into the proliferative phase of healing.¹ HAM provides a natural cellular scaffold for cellular adhesion facilitating keratinocyte migration to promote reepithelialisation and enable remodelling to accelerate wound healing.¹ High quality studies with good evidence specify the safe and effective use of HAM in the management of diabetic foot ulcers.²,³

Editorial

Nick Kairinos — 2023-06-30

I am not sure if the articles in the last two issues on how to undertake research and how to write and publish an article have anything to do with it or whether it’s because the journal is now accredited, but we have had a record number of submissions for this last issue. Unfortunately, they were almost all submitted in the last two months before publication, leaving us with five articles ready for publication. Please remember that the peer-review process takes time, as will the subsequent revisions you may need to make should your article be accepted. So please submit timeously if you would like your article published in the next issue.