Here - EWMA 2013

E-POSTER PRESENTATIONS
EP 492
From secondary intent to accelerated reconstruction
– the prospect of dermal scaffolds
E-Poster: Dressings
Julian Dye 1
1 RAFT institute, Mount Vernon Hospital (Middlesex, United Kingdom).
Artificial skin strategies have not been as successful as hoped, and there is still an
urgent un-met clinical need for effective methods for full-thickness skin-loss
reconstruction. A novel cross-linked fibrin-alginate porous composite has been
developed as a pro-vascular synthetic dermal scaffold* to improve on host integration &
long-term outcomes of some previous biomaterials. Neo-vascularisation rate could limit
both speed and outcome (from lack of integration, fluid accumulation, inflammation,
infection). The pro-angiogenic properties of fibrin accelerate integration via biological
interactions with the wound bed tissues.
The prototype synthetic dermal scaffolds were evaluated in a full-thickness porcine skinexcision
wound model, with/without a wound-ring or split-thickness skin graft (single step
full-thickness reconstruction).
The synthetic dermal scaffold demonstrated deep vasculogenesis and cellular ingress
within 7 days. By week 3, scaffold/tissue contraction was ≤20% and resulting neodermal
tissue showed diminishing αSMactin positive fibroblasts and αSMactin positive
capillaries. Optimised synthetic dermal scaffold was completely cellularised and
vascularised by day 7. This was rapid enough for successful single-stage full-thickness
reconstruction. At week 6 the neodermis resembles surrounding skin both by palpation
and cellular organisation, which lacks obvious adnexal structures but has features
consistent with regenerated tissue. Application of tissue scaffolds, particularly synthetic
dermal scaffold, in the partial burn excision model can switch the wound bed to an
accelerated regenerating mode. Instead of protracted healing by secondary intent, the
suynthetic dermal scaffold might benefit some wounds substantially to accelerate and
organize healing and minimise complications.
*Smart Matrix (SM-SDR)
E-POSTER: EDUCATION
EP 493
E-Poster: Education
Creating Champions for Skin Integrity: Facilitating the uptake of
evidence based wound management in residential aged care
Christina Parker 1 , Helen Edwards 1 , Kathleen Finlayson 1 , Anne Chang 2 , Michelle Gibb 1
1 Queensland University of Technology (Brisbane, Australia);
2 Mater Health Services (Brisbane, Australia).
Aim: To implement sustainable evidence based wound management in Residential Aged
Care Facilities (RACFS) and to enable staff to preserve skin integrity through application
of evidence-based assessment, management and prevention of wounds.
Methods: The Champions for Skin Integrity model and resources were developed,
implemented and evaluated in seven RACFs, ranging from 20 – 500 beds. The six
month implementation phase included a series of on-site visits with intensive education,
consultation, resource development and skills development sessions on evidence based
strategies to prevent assess and manage common wound types. Data on point
prevalence and management of wounds were collected via a clinical and chart audit of a
random samples of residents (n = 401, 200 pre-implementation and 201 postimplementation).
Results: Demographic characteristics were similar across both samples, with 68% of
residents female and an average age of 85 years. Analysis of data found a significant
decrease in the prevalence of wounds and increased levels of implementation of
evidence based strategies to prevent and manage wounds in the post-implementation
survey in comparison to the pre-implementation survey.
Conclusions: Results from this project provide important information on the
effectiveness of the Champions for Skin Integrity model and strategies in achieving
improved outcomes for residents and increased implementation of evidence based
wound management and prevention strategies.
This Project was funded by the Australian Government Department of Health and Ageing under the Encouraging
Best Practice in Aged Care program.
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