Biomedical subjects
S Meaume
Publications and source records attributed to S Meaume.
[Supports to aid in prevention and care].
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[Evidence based medicine and the treatment of wounds].
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[News in the management of chronic neuropathic diabetic ulcer].
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[Decubitus ulcer. Etiology, physiopathology, prevention].
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[Normal and pathologic scarring. Physiopathology and anatomic pathology].
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[Use of growth factors for treatment of chronic wounds. Results of controlled studies].
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[Superficial scars and hydrocolloids].
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[Decubitus sores in geriatric medicine. Local and general treatment of pressure sores in the aged].
LOCAL CARE: Local antiseptics and antibiotics must be avoided to preserve the local bacterial ecosystem of the wound. If surgical debridement is not possible, hypercolloid, alginate or hydrogel dressings should be applied to achieve natural autolytic cleansing. The budding and epithelization phases are also treated either with oily or humid dressings or more modern hypercellular, hydrocolloid and polyurethane film dressings. Other treatments under evaluation include physical means (negative pressure, electrical stimulation) or use of recombinant growth factors. GENERAL TREATMENT: Surgical repair with flaps or grafts is not usually indicated in fragile elderly patients. Special attention must be given to all associated diseases (diabetes, heart failure, etc.) as well as protein-calorie nutrition. The objective is 35 cal/kg/d including 1.25-1.5 g protein/kg/d. TREATMENT OF COMPLICATIONS: Wound infection should be suspected in case of an inflammatory induration around the wound, fever, or delayed healing. Systemic antibiotics are indicated as for cellulitis. The wound is generally colonized by germs found on local bacteriological samples. Osteitis should be suspected if the wound is in contact with bone. In case of biopsy proven osteitis with positive culture, prolonged oral antibiotics are indicated. Tendon retractions should benefit from rehabilitation exercises and surgery in case of medical failure. Antalgesics may be required, either continuously or when making the dressings.
[Prevention of decubitus scars in the elderly].
IDENTIFYING RISK: Groups of elderly patients at risk of pressure sores must be carefully identified for effective prevention. Recommended risk scales are insufficiently used in everyday practice. Preventive measures must be rapidly implemented in order to reduce or eliminate factors contributing to the development of pressure sores. Risk factors include, among others, prolonged or heavy pressure, friction, shearing force, malnutrition, and bowel incontinence. POSITION: The position of patients with severe sensorial disorders should be changed every 2 or 3 hours. Bed rest should be interrupted as soon as possible, using a cushioned chair. Reclining in the strictly lateral position (with pressure on the trochanter) must be avoided. A 30 degrees dorsal inclination in the lateral position is preferable. The reclining-sitting position with a greater than 30 degrees inclination should be avoided as it increases the shearing forces applied to the sacrum. The ventral position is inappropriate for the elderly. PREVENTION AIDS: Mattresses, mattress covers, cushions and various other aids have been developed specifically for the prevention of pressure sores but the evaluation and choice of material requires careful assessment using pressure sensors. GENERAL MEASURES: Instruments designed to facilitate position changing help reduce the risk of friction. The general practice of massage, widely used in France, is not based on confirmed arguments of efficacy. On the contrary, certain studies would show that such methods can have unfavorable effects. Prevention of undernutrition and renutrition cannot be overlooked. Maintaining the patient in a dry environment (particularly in case of incontinence) and use of emollients to prevent skin drying are recommended. Written prevention protocols for education of patients, family, and health care personnel are indispensable.
Sarcopenia, hypermetabolism, and aging.
Sarcopenia is a constant in aging. Observed over long periods, it can reach 1% per year. But it is such a tenuous phenomenon that it cannot be observed over short periods at steady state. The aging phenomenon mainly hits fibers, Type II but on aged muscle thin, normal, and hypertrophic fibers cohabit with sclerosis and fat increases. Sarcopenia is difficult to study, due to the lack of simple clinical, biochemical, or imaging measures. Anthropometric data are largely dependent on water content. DEXA gives better information on appendicular muscle loss. Measures of strength analyze functional outcomes of sarcopenia. Sarcopenia appears largely multifactorial. Hormonal changes, e.g., drop in growth hormone, menopause, and andropause, explain impaired protein synthesis. Disuse (sedentary, bed rest) may explain chronical protein lysis. But the main factors for muscle lysis imply life events and occurring diseases. Cytokines (IL6, TNF alpha) and stress hormones (cortisol) induce quick protein lysis in muscle. Rapid and intensive successive aggressions during life cannot be compensated by slowed synthesis. Harmful consequences of sarcopenia explain many disabilities of old age: loss of strength, inducing itself loss of mobility, falls, equilibrium disorders, poor ADL: loss of nutritional reserves (protein and glycogen) impairing capacities of immune response. Muscle loss spoils vital functions as respiration. Treatment remains rather limited to resistance exercise. Although, these results are thin, they are the only ones to be validated in all the elderly even the frail or the old. However it is not efficient during the evolution of an inflammatory process. The powerful action of cytokine and cortisol on muscular hypermetabolism must be incited for early treatment of any infectious or inflammatory event. Nutritional supplementation has no efficiency in the absence of malnutrition and without exercise. Although mobility impairments mainly due to sarcopenia are the first cause of disablement in the elderly, we lack information on etiology, evolution, and measurement of sarcopenia. We also lack controlled therapeutical studies.
[Rapid healing of venous ulcers and lack of clinical rejection with an allogeneic cultured human skin equivalent].
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[Pain and decubitus ulcers in the aged].
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[Wet wound debridement, an essential part of wound healing].
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Healing properties of calcium alginate dressings.
In a prospective, randomised, controlled trial of 92 patients with full-thickness pressure ulcers, the efficacy of an alginate wound dressing was compared to that of an established local treatment with dextranomer paste. During treatment, a minimal 40% reduction in wound area was obtained in 74% of the patients in the alginate group and in 42% of those in the dextranomer group. The median time taken to achieve this goal was four weeks with alginate and more than eight weeks in the control group. Mean surface area reduction per week was 2.39 cm2 (sd 3.54) and 0.27 cm2 (sd 3.21) in the alginate and dextranomer groups respectively (p = 0.0001). This difference was still highly significant when the sub-groups of almost completely healed subjects at the end of the study were considered. This striking healing efficacy of an alginate dressing suggests it possesses pharmacological properties which require further investigation.