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Future events The Joint DGfW, ETRS and EWMA conference , and the 6th Annual Scottish Conference Revisiting the role of Moisture in Wound Healing	Welcome to the 4th Wounds UK Newsletter It would appear that the conference season is almost upon us and with it comes the promise of new and exciting research, a chance to network with experts and above all recharge our enthusiasm for wound, leg ulcer and pressure ulcer treatment and management. My overwheliming memories of valuable conferences are not only of the ground breaking work which is taking place but the sense of community that those involved in the treatment of chronic wounds share. Knowing that others have similar issues with 'difficult wounds' helps us to feel that it is a pursuit which is extremely worth while. Those not involved in this field can be quite dismissive in relation to its importance, however, the profile of wound management becoming more difficult to ignore in the face of patient quality of life issues, infection and also the financial burden involved. It is therefore essential that we maintain our enthusiasm and continue as a group to influence those around us, in particular responsible for health policy need to be supportive of this field and those within it in order to positively influence patient care. John Timmons Editor Email: John.Timmons@gcal.ac.uk	References Latest journal references

Future events The Joint DGfW, ETRS and EWMA conference will take place in Stuttgart in September from the 14th until the 17th. The conference entitled 'From the laboratory to the patient: Future organisation and care of problem wounds'. The conference will be fully Bi-lingual in German and English and the programme includes a number of extremely intersting sessions which attempt to 'Bridge the Gap' from the research to the patient and how this can influence care and outcomes. This unique blend of science and patient care issues should provide an excellent forum for all interested in wound management. The 6th Annual Scottish Conference run by Wounds UK will be held in Glasgow on September the 8th. This very popular event has attracted large numbers of practitioners and the programme includes and excellent variety of speakers addesssing a number of key current topics in wound and leg ulcer management.   Keep reading for: Revisiting the role of Moisture in Wound Healing Latest journal references Download this newsletter in PDF format Revisiting the role of Moisture in Wound Healing Understanding the role of moisture in wound healing is an essential part of any wound practioners knowledge base. Wound bed preparation, TIME and Applied Wound Management Frameworks (AWM) all emphasis the importance of trying to not only quantify moisture levels, but the AWM asks us to examine the detail of moisture produced by the wound (Gray, White Kingsley and Cooper 2005 Thomas 2001, and Ayello et al 2004). Perhaps as a result of the moist wound healing theory which emerged in the 1960's, we have been of the opinion that moisture is always good. This, although true to some extent is a somewhat simplistic view particularly in the case of chronic wounds and the exudate produced by them. Other issues such as bacteria and necrotic tissue often take precedence over the treatment of excessive or lack of moisture. In addition, we can make a concrete attempt to treat bacteria or necrotic tissue by applying antimicrobial products or by physical debridement, however, moisture can be more difficult to control. Recent studies of chronic wound exudate have revealed a number of problems which could be responsible for interupting the wound healing process. High levels of proteinases (proteolytic enzymes) have been identified which can destroy the extracellular matrix which directly impacts on new tissue growth and eventually lead to destruction of existing tissue (Greener, Hughes, Bannister and Douglass 2005). It has also been found that the pH of chronic wound exudate is more alkaline than would be ideal for wound healing to take place, with key cells such as fibroblasts an acidic environment is preferable (Greener et al 2005). We are possibly sometime away from a strip which resembles that of a urinalysis style test to place on chronic wounds and examine the wound fluid. It is therefore a possibility that non healing chronic wounds may have a level of exudate which is not of ideal pH, contains an imbalance of proteases and also produces high levels of exudate which may lead to maceration. Vowden and Vowden in White ed. (2004) suggest that effective exudate management consists of : optimizing the wound environment Controlling inefective load Protecting surrounding skin Maximizing the patients quality of life by preventing leakage, contolling odour and reducing wound related pain. It is also important to note the following: Moist wound healing is still the best way to support the healing process. Key cell types and growth factors need a certain moisture level in which to function although the optimum moisture level is unknown. Chronic wound exudate often may contain excess amounts of proteolytic enzymes which can degrade the wound, including new cells and prevent wound healing. When addressing the issue of wound exudate we should always consider a therapy which not only works for the wound but also one which is acceptable to the patient. Key issues to consider when selecting a therapy include: the performance of the dressing, surounding skin, bacterial burden, the use of other dressings or therapies (e.g. compression) and what are the overall aims of treatment (Vowden et al 2004) AYELLO, ELIZABETH A. DOWSETT, CAROLINE SCHULTZ, GREGORY S. SIBBALD, R. GARY FALANGA, VINCENT HARDING, KEITH ROMANELLI, MARCO STACEY, MICHAEL TÉOT, LUC VANSCHEIDT, WOLFGANG MD TIME heals all wounds Nursing: Volume 34(4) April 2004 pp 36-42 Gray D White R Cooper P and Kingsley A (2005) Understanding Applied Wound Management, Wounds UK Vol 1 No. 1 p62-68 Greener B Hughes AA Bannister NP and Douglass J (2005) Proteases and pH in chronic wounds, Journal of Wound Care Vol 14 No 2. Thomas D (2001) Matrix metalloproteinases, Tissue inhibitors of metalloproteinases and wound bed status: in : Cherry GW, Harding KG and Ryan TJ, eds. Wound Bed Preparation The Royal Society of Medicine Press London 17-23. Vowden K and Vowden P (2004) The role of exudate in the wound healing process, in Trends in wound care III White ed. P 9-21. Mark Allen Publishers Keep reading for: Latest journal references Download this newsletter in PDF format Latest Journal References Brown, J.(2005) The role of the fibrin cuff in the development of venous leg ulcers JOURNAL OF WOUND CARE VOL 14; NUMB 7; pp. 324-328 Dobke, M. K.; Nguyen, D.; Trott, S. A. (2005) Case Series A Novel Approach to Acute Infection of the Glenohumeral Joint Following Rotator Cuff Repair-A Case Series WOUNDS VOL 17; NUMB 6; pp. 137-140 Dormand, E. L.; Banwell, P. E.; Goodacre, T. E. (2005) Radiotherapy and wound healing INTERNATIONAL WOUND JOURNAL VOL 2; NUMBER 2;pp. 112-127 Enoch, S.; Kupitz, S.; Miller, D. R.; Harding, K. G. (2005) Dystrophic calcification as a cause for non healing leg ulcers INTERNATIONAL WOUND JOURNAL VOL 2; NUMBER 2 pp. 142-147 Hardikar J. V.; Reddy, Y. C.; Bung, D. D.; Varma, N.; Shilotri, P. P.; Prasad, E. D.; Rao, G. S.; Satyanarayana, G.; Suresh, K. R.; HEALACE Study Group (2005) Original Research Efficacy of Recombinant Human Platelet-Derived Growth Factor (rhPDGF) Based Gel in Diabetic Foot Ulcers: A Randomized, Multicenter, Double-Blind, Placebo-Controlled Study in India Hardikar, WOUNDS VOL 17; NUMB 6; pp. 141-152 Hensen, P.; Ma, H. L.; Luger, T. A.; Roeder, N.; Steinhoff, M. (2005) Pathway management in ambulatory wound care: defining local standards for quality improvement and interprofessional care INTERNATIONAL WOUND JOURNAL VOL 2; NUMBER 2 pp. 104-111 Konig, M.; Vanscheidt, W.; Augustin, M.; Kapp, H.(2005) Enzymatic versus autolytic debridement of chronic leg ulcers: a prospective randomised trial JOURNAL OF WOUND CARE VOL 14; NUMB 7; pp. 320-323 Lakshman, S.; King, S. R.; Wallace, R. D. (2005) Case Report Case Report: The Use of Dermal Substitute in the Reconstruction of Full-Thickness Burns to the Penis WOUNDS VOL 17; NUMB 6; p. 153 Lindholm, C.; Andersson, H.; Fossum, B.; Jorbeck, H. (2005) Wounds scrutiny in a Swedish hospital: prevalence, nursing care and bacteriology, including MRSA, Martin, B. R.; Sangalang, M.; Wu, S.; Armstrong, D. G. (2005) Outcomes of allogenic acellular matrix therapy in treatment of diabetic foot wounds: an initial experience INTERNATIONAL WOUND JOURNAL VOL 2; NUMBER 2 pp. 161-165 Meaume, S.; Ourabah, Z.; Cartier, H.; Granel-Brocard, F.; Combemale, P.; Bressieux, J. M.; Bohbot, S. (2005) Evaluation of a lipidocolloid wound dressing in the local management of leg ulcers JOURNAL OF WOUND CARE VOL 14; NUMB 7 pp. 329-336 Scanlon, E.; Karlsmark, T.; Leaper, D. J.; Carter, K.; Poulsen, P. B.; Hart-Hansen, K.; Hahn, T. W. (2005) Cost-effective faster wound healing with a sustained silver-releasing foam dressing in delayed healing leg ulcers - a health-economic analysis INTERNATIONAL WOUND JOURNAL VOL 2; NUMBER 2pp. 150-160 Qin, Y.(2005) Silver-containing alginate fibres and dressings INTERNATIONAL WOUND JOURNAL VOL 2; NUMBER 2pp. 172-176 Zuloaga-Salcedo, S.; Contreras-Ruiz, J.; Dominguez-Cherit, J.; Vega-Memije, E. (2005) An approach to the management of necrotising fasciitis in neonates INTERNATIONAL WOUND JOURNAL VOL 2; NUMBER 2 pp. 178-180   Download this newsletter in PDF format