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Skin Integrity and Pressure Injuries

Normothermic Dressings

Heat has been used for centuries because of its positive effects on wound healing (Kloth et al. 2000). Heat when applied to healthy skin causes vasodilation resulting in an increase in blood flow and oxygen delivery to tissues (Rund & Sussman 2007). This has led to a belief by some, that these effects may be beneficial for wounds such as pressure injuries where perfusion is compromised by pressure (Kloth et al. 2000). Normothermia is the application of controlled levels of radiant-heat energy to a wound (Consortium of Spinal Cord Medicine 2000; Kloth et al. 2000).

Author Year
Country
Research Design
Sample Size

Methods

Outcome

Kloth et al. 2000
USA
Prospective Controlled
Trial
N=20
Population: Treatment group: Mean age=65.4 yr; Pressure injury stage: III=9, IV=7; Number of pressure injuries: SCI=7, Geriatrics=8. Control group: Mean age=59 yr; Pressure injury stage: III=3, IV=3; Number of pressure injuries: SCI=3, Geriatrics=3.
Intervention: A semiocclusive heated dressing applied (38°C) to treatment groups’ ulcers 4.5 hrs/day, Monday to Friday, for 4 wks. Heating element delivered two 60 minute periods of warmth with 1 hr of no heat between and at the end of treatment session. Standard wound care was received by both groups.
Outcome Measures: Peak daily skin temperature; change in wound surface area.
1. Treatment group’s skin temperature increased 88°C inside and 1.86°C outside the pressure injury on average, between baseline and end of a session (p<0.05).
2. Treatment group’s pressure injury surface area improved significantly when compared to the control group (60.73% and 19.24% respectively, p<0.05).

Discussion

In a four-week controlled trial of fifteen stage III and IV pressure injuries where almost 50% of the wounds were post-SCI, Kloth et al. (2000) reported a 61% reduction in WSA for wounds treated with a normothermic dressing. In the six control wounds treated with standard wound care, there was a 19% reduction in WSA.

Conclusion

There is level 2 evidence (from one prospective controlled trial: Kloth et al. 2001) that normothermic dressings may improve healing of pressure injuries post-SCI.

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