International Wound Journal最新文献

Vasculitic and pyoderma gangrenosum ulcers are traditionally treated with immunosuppressants, and the role of surgery in the treatment of these atypical ulcers remains unclear. This study aimed to investigate the need for surgical intervention as well as the outcome and safety of skin grafting in the treatment of 46 patients with vasculitic ulcers and 34 with pyoderma gangrenosum ulcers using data recorded in the validated Wound Registry. Of the 80 patients with atypical ulcers, 14% (n = 11) were treated surgically; these patients were older (p = 0.039), had lower mobility status (p = 0.002), and more often pulmonary diseases, rheumatoid arthritis, and previous arterial procedures (p = 0.007; p = 0.031; p = 0.031, respectively) than those treated conservatively. Of 181 ulcers, 15% (n = 27) were surgically treated, 78% once and 22% multiple times. During follow-up, 92.3% of both surgically and conservatively treated ulcers with available data healed. Of the surgically treated ulcers, median healing time after first surgical procedure was 96 days, and post-surgical complications were considered mild or unrelated to surgery. Our results suggest that if surgery is indicated, skin grafting is a safe and efficient treatment method provided that multidisciplinary approach is applied.

We read with great interest the article titled ‘Antibiotic bone cement accelerates diabetic foot wound healing: Elucidating the role of ROCK1 protein expression’ by Yang C et al.¹ This study revealed that antibiotic bone cement enhanced diabetic foot wound healing, possibly via upregulation of ROCK1. However, we found that there were few questions to be solved.

Firstly, in the Results section, the authors applied vancomycin antibiotic bone cement to the wound after rigorous debridement in the experimental (EXP) group. They observed notable healing distally at the ankle joint, which facilitated limb preservation. The adaptation of the vancomycin bone cement technique demonstrated that antibiotic bone cement could offer a localized, sustained antibiotic release, mitigating infection risks and systemic antibiotic side effects while creating a conducive microenvironment for wound healing. However, based on the preoperative bacterial culture results, the Gram-negative bacteria, including proteus, pseudomonas aeruginosa, kleber pneumoniae and baumanii, accounted for 27.5% of the total number of cultured bacteria in the EXP group. Vancomycin is effective against most Gram-positive bacteria but has limited activity against Gram-negative bacteria, and is not typically used to treat infections caused by Gram-negative bacteria. We seek to understand whether the application of vancomycin bone cement in treating diabetic foot ulcers with these insensitive bacterial infections, as mentioned in the article, can also achieve the same ideal therapeutic effects. Based on our clinical treatment experience, using bone cement with other antibiotics that is sensitive to the bacteria could lead to better therapeutic outcomes. The efficacy of antimicrobial agents is crucial to the success of diabetic foot therapy.

Secondly, the authors reported that diabetic foot cases with peripheral arterial disease constitute 70% of the cases in each group. Ischemia is the most critical factor impeding the healing of diabetic foot lesions.² The assessment of the anatomical location, morphology and extent of vascular lesions facilitates decision-making regarding the treatment. Further diagnosis needs to be made based on the following parameters such as the ankle-brachial index (ABI) and toe-brachial index (TBI), transcutaneous oxygen pressure (TcPO2). The management of peripheral arterial disease encompasses antiplatelet therapy, vasoactive drug therapy and revascularization. The healing rate of foot ulcers notably increases after direct or indirect vascular reconstruction surgery.³ Brownrigg et al. reported lower limb revascularization could achieve a limb preservation rate of 80%–85% within 12 months and an ulcer healing rate >60%.⁴ To address our concerns, the article could clarify the treatment methods and outcomes for vascular lesions in the lower limbs of patients ac

The study aimed to evaluate the effect of an intervention on the prevalence and severity of incontinence-associated dermatitis (IAD) in six hospitals in one state in Australia. This quasi-experimental pre-and post-study, conducted in 18 wards, was part of a larger implementation science study on incontinence-associated dermatitis. Skin and incontinence assessments were conducted on patients during February and March 2020 (pre-intervention) and July and August 2021 (post-intervention). The intervention comprised continence assessment and management, an education brochure for patients, family and caregivers on IAD, the Ghent Global IAD Categorisation Tool (GLOBIAD) and a skin care regime with patient skin protection measures (three-in-one barrier cream cloths, minimisation of bed protection layers, use of appropriate continence aid). A total of 1897 patients were assessed (pre-intervention = 964, post-intervention = 933). A total of 343 (35.6%) pre-intervention patients and 351 (37.6%) post-intervention patients had incontinence. The prevalence of hospital-acquired IAD was 6.71% in the pre-intervention group and 4.27% in the post-intervention group; a reduction of 36.3% (p = 0.159) despite higher patient acuity, prevalence of double incontinence and the COVID-19 pandemic in the post-intervention group compared with the pre-intervention group. Our multisite best practice IAD prevention and treatment intervention was able to reduce the prevalence and severity of hospital-acquired IAD, suggesting enduring effectiveness of the intervention.

We read your recent article titled “Cardiovascular Risk Profile in Burn Survivors: A Study from a Burn Center in North Iran” with great interest. Firstly, we commend the authors for assessing downstream cardiovascular risk in burn survivors. While the study provides valuable insights, there are considerations that warrant further reflection and discussion.

Firstly, there is a drawback in the study design. Although the authors found an association between burn injuries and cardiovascular risk, they never compared burn patients with a non-burn control group. Without this comparison, it is challenging to determine if burn injuries are independently associated with CV risk. A control group of non-burn patients would provide a baseline for understanding the potential impact of burn injuries on CV health. A study found that burn and non-burn trauma patients had cardiovascular disease (CVD) admission rates that were 50% and 30% higher, respectively, compared with a group of non-injured individuals matched by age and gender from the general population.¹

Secondly, the study acknowledges potential confounders such as age, gender, diabetes and hypertension. However, there may be other unmeasured confounders, including socioeconomic status, sociobehavioural factors (e.g., diet, smoking and sleep) and access to healthcare. The varying incidence of cardiovascular disease (CVD) morbidity and mortality based on socioeconomic status (SES), primarily determined by income, occupation and education, underscores the necessity of considering factors beyond traditional risk factors when assessing an individual's overall CVD risk.² According to a recent study in Iran, weight, sleep patterns and lifestyle were identified as additional modifiable risks significantly linked to cardiovascular disease (CVD).³

Moreover, a detailed analysis of the pathophysiological processes following burn injuries and their impact on CV risk would enhance the study's credibility and contribute to a deeper understanding of this relationship. Severe fluid shifts that occur after the initial injury, combined with high-volume fluid resuscitation, have a significant impact on the cardiovascular system. Increased inflammation and hypermetabolic syndrome contribute to cardiac dysfunction, leading to poorer outcomes in burn patients. This type of injury results in reduced cardiac output, necessitating a compensatory increase in heart rate and peripheral resistance.⁴ A study found that injuries affecting the skin, such as burns and open wounds, had a more substantial impact on post-injury CVD admission rates than injuries with closed fractures. This suggests that the nature of the injury and its impact on the body's systemic responses contribute to the varying levels of CVD risk.¹

Lastly, study's focus on a single burn centre in North Iran may limit its ge

Laura K. S. Parnell, Gregory Schultz and John Steinberg

The Medstar Georgetown Diabetic Limb Salvage and the Wound Healing Foundation, both nonprofit organizations, recently held a meeting on the Diabetic Foot in Washington D.C., USA. These groups chose the International Wound Journal to feature their submitted abstracts to highlight the excellent research ongoing in this important clinical area. If you wish to get in touch with any of the authors to discuss their research, please contact us and we can connect you.

Editorial Note: We recognize the valued contribution of Professor Greg Schultz and his connection with the IWJ to make this possible. With sadness we acknowledge his passing while attending this meeting. His legacy continues even after his passing.

Poster numbers are identified in the order they were submitted.

*Identified as a top oral abstract presenter.

Necrotizing fasciitis (NF) is a rare, dangerous, potentially fatal infectious disease of soft tissue. The treatment consists of antibiotic therapy, surgical debridement and subsequent reconstruction. Hyperbaric oxygen (HBO) therapy has been applied in NF patients recently, so our aim was to gather the findings and outcomes for HBO therapy. A PubMed and Google Scholar literature search was conducted regarding the effect of HBO therapy in patients with NF following key words: ‘necrotizing fasciitis’ AND ‘maxillofacial region’ OR ‘head and neck’ AND ‘hyperbaric oxygen’ OR ‘HBO’. A total of 3333 studies have been identified, of which only 16 articles met the inclusion criteria of this review. A conclusion was made, that aggressive combinations of antibiotics and surgical debridement followed by incorporation of HBO therapy, as an adjuvant treatment, in patients with NF and in company by immunoglobulin therapy are showing promising results. In addition, multi-centric studies should be in consideration for further research.

Bacterial infection is the most common complication in wound healing, highlighting an urgent need for the development of innovative antibacterial technologies and treatments to address the growing threats posed by bacterial infections. Black phosphorus nanosheets (BPNSs), as a promising two-dimensional nanomaterial, have been utilized in treating infected wounds. However, BP's limited stability restricts its application. In this study, we enhance BP's stability and its antibacterial properties by anchoring gallium ions (Ga³⁺) onto BP's surface, creating a novel antibacterial platform. This modification reduces BP's electron density and enhances its antibacterial capabilities through a synergistic effect. Under near-infrared (NIR) irradiation, the BP/Ga³⁺ combination exerts antibacterial effects via photothermal therapy (PTT) and photodynamic therapy (PDT), while also releasing Ga³⁺. The Ga³⁺ employ a ‘Trojan horse strategy’ to disrupt iron metabolism, significantly boosting the antibacterial efficacy of the complex. This innovative material offers a viable alternative to antibiotics and holds significant promise for treating infected wounds and aiding skin reconstruction.

Recently, we were honoured to read Dr. Xiao et al.'s ‘Risk factors for surgical site infection after percutaneous endoscopic lumbar discectomy’. This study retrospectively analysed the clinical data of 335 patients with surgical site infection (SSI) after percutaneous endoscopic lumbar discectomy (PELD) and concluded that high BMI, diabetes, long-term use of corticosteroid, long operation time and cerebrospinal fluid leakage were independent risk factors for SSI.¹ We are very grateful for the author’s contribution in this field, but there are still some problems in this study that need to be further explored.

First, although this study explored that long-term use of corticosteroids before surgery increased the incidence of SSI after PELD, the concept of long-term use of corticosteroids was not defined. A meta-analysis of whether long-term preoperative corticosteroid use affects the outcome of orthopaedic surgery included patients who required regular oral or parental corticosteroid therapy for chronic diseases within 30 days before surgery, excluding patients who received a limited short-term course of treatment (≤10 days) or took topical, inhaled and rectal steroids.² Secondly, this study lacks a discussion on whether preoperative local injection of corticosteroids will affect the incidence of SSI. It has been reported that local injection of corticosteroids within 4 months before surgery will increase the risk of postoperative periprosthetic infection and surgical site infection.³ Interestingly, in addition to the various factors discussed by the authors, environmental factors also have an impact on the incidence of postoperative SSI. Spinal surgery performed in the warm season has a higher incidence of SSI.⁴ The reason for this phenomenon may be that posterior surgery causes poor ventilation of the patient's incision and bacteria are easy to breed in warm and humid environments.

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Retraction: X. Chen, Y. Xu, X. Meng, R. Geng, X. Wang, G. Zhang, and L. Bai, “Analysis of the Association Between Serum Levels of 25(OH)D, Retinol Binding Protein, and Cyclooxygenase-2 and the Disease Severity in Patients with Diabetic Foot Ulcers,” International Wound Journal 21, no. 3 (2023): e14502, https://doi.org/10.1111/iwj.14502.

The above article, published online on 16 November 2023, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the journal Editor in Chief, Professor Keith Harding; and John Wiley & Sons, Ltd. Following an investigation by the publisher, both parties concluded that the peer review process of this article was manipulated. In addition, the authors reported to the journal that values for statistics were not labelled properly in Figures 1, 2, and 3 and that they had misreported data from a cited article. The retraction has been agreed to because the findings reported in the article are not considered reliable. The authors did not respond to the notice of retraction.

Early wound intervention and closure is critical for reducing infection and improving aesthetic and functional outcomes for patients with acute burn wounds and nonthermal full-thickness skin defects. Treatment of partial-thickness burns or full-thickness injuries with autologous skin cell suspension (ASCS) achieves robust wound closure while limiting the amount of donor skin compared with standard autografting. A Next Generation Autologous Cell Harvesting Device (NG-ACHD) was developed to standardize the preparation process for ASCS to ensure biological attributes are obtained known to correlate with well-established safety and performance data. This study compared ASCS prepared using the NG-ACHD and ACHD following the manufacturer's guidance, evaluating cellular yields, viability, apoptotic activity, aggregates, phenotypes and functional capacity. Non-inferiority was established for all biological attributes tested and comparable healing trajectories were demonstrated using an in vitro skin regeneration model. In addition to standardization, the NG-ACHD also provides workflow efficiencies with the potential to decrease training requirements and increase the ease of incorporation and utilization of ASCS in clinical practice.