International Wound Journal最新文献

M. Antoszewska, K. Połomska, P. Spychalski, A. Kekonen, J. Viik, and W. Barańska-Rybak, “ Bioimpedance Measurement for Monitoring Chronic Wounds: A Systematic Review,” International Wound Journal 22 (2025): e70707, https://doi.org/10.1111/iwj.70707.

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The aim is to assess the incidence of pressure ulcers among adults undergoing surgery. Systematic review methodology was employed. Databases including Cochrane, Ovid Medline, Embase, EBSCO, CINAHL Plus and Scopus were searched in August 2024. The data extracted were imported into Excel for analysis. Simple descriptive statistics were used for the analysis purposes. The data are presented using means and standard deviations. The evidence-based Librarian checklist was used for the quality appraisal. The Systematic Review Protocol was registered in PROSPERO (CRD42023449194). A total of 35 studies were included. The mean pressure ulcer incidence was 17.22% (range from 0.05% to 74.2%). Studies from orthopaedics, mainly including patients undergoing hip surgeries, reported the highest pressure ulcer incidence. The most commonly reported pressure ulcer grade was stage one, and the most common anatomical locations were the sacral region and heels. Pressure ulcers remain a significant concern for surgical patients, especially those undergoing orthopaedic and cardiac surgeries. Most develop in early stages, often affecting the sacral and heel regions. However, gaps in data make it difficult to fully synthesise the scope of the problem. Standardised reporting and targeted prevention efforts are essential to reducing incidence and improving patient care.

Neonatal skin injuries are common, but location and metric size contribute to inconsistent severity reporting. To date, non-invasive technologies remain unexplored for neonatal injuries. The aim of this study was to assess the feasibility and accuracy of visual assessment against three technologies for injuries to the skin from pressure, stripping and tearing. The prospective diagnostic/feasibility study was conducted for neonates who acquired mechanical force injuries between February–July 2022. Injury measures taken within 72 h of identification were (i) skin injury severity or type pH (5.0–7.5), (ii) laser speckle (perfusion units/mm²), and (iii) imaging app (surface area, cm²). Technology feasibility, clinician-reported acceptability, accuracy, cost and injury sequelae at 6 months post-injury were also collected. A total of 24 neonates (mean (SD)) 34 (5) weeks old and (median (IQR) weight) 1244 (868 to 1740) grams were enrolled. Forty injuries (n = 120 assessments) were completed by visual assessment (100%), 34 (85%) by pH, 30 (75%) with laser speckle and 38 (95%) with the imaging app, respectively. Assessments between clinicians and researchers were inconsistent (n = 29, 72%) and technologies failed for at least 3% of assessments by each respective device. Median injured pH exceeded healthy (average −0.7 of unit), but differences between injured and healthy skin with laser speckle and the app were non-significant. Skin pH had the quickest acquisition (mean (SD) 3.1 (1.6) min) followed by the app (3.2 (2.5) min) and mean acceptability was highest for the imaging app (7.1/10), then pH (6.4/10). Cost per injury was most expensive for the app ($6.65 to $12.82) and lowest for pH ($0.17 to $0.41) per assessment. In conjunction with visual assessment, pH appears objective and cost-effective for intact and injured skin comparison.

Chronic wounds represent a substantial socioeconomic, financial, and psychological burden. We examine preclinical and clinical evidence assessing the impact of chronic wounds on negative affect, cognition, and quality of life and discuss potential mechanisms underlying the link between chronic wounds and negative affect and cognition. There is limited preclinical evidence examining negative affect and wounds, but anxiety-related behaviour has been reported in a rat incisional wound model. The incidence of anxiety and depression in people with chronic wounds varies considerably. Potential mechanisms underlying the link between chronic wounds and negative affect include the immune system, pain, metabolic dysfunction, inflammation, and vascular damage. There is a paucity of both preclinical and clinical studies examining the effect of chronic wounds on cognition, highlighting a need for more studies in this area. Research suggests that there are deficiencies in the management of anxiety, depression, and cognitive impairment in people with chronic wounds, but developing and administering therapies that target these comorbidities may have a positive impact on quality of life and wound healing. Integration of mental health and cognition screening into wound care protocols would provide substantial benefits both socioeconomically and to individuals with chronic wounds.

Chronic and non-healing wounds are a global health issue with limited effective treatments. Wound care costs continue to rise, highlighting the need for new therapies. Medicinal plants, particularly African species, show promise for enhancing wound healing. This review analysed 93 studies and identified 37 relevant to wound healing, covering 39 plant species. Ten species were identified for their rich phytochemical content, specifically flavonoids, terpenoids, and alkaloids (plant-derived compounds). These compounds act synergistically, enhancing the wound healing process at each stage. Flavonoids reduce inflammation and support tissue turnover, while terpenoids enhance collagen production and wound closure. Alkaloids offer antimicrobial benefits and support wound contraction. Notable plants include Ageratum conyzoides and Aspilia africana (Asteraceae family); promoting haemostasis by lowering plasma fibrinogen and enhancing platelet-derived growth factors; Withania somnifera (Solanaceae); and Entada africana (Fabaceae), effectively regulating inflammation. In the proliferative phase, Ocimum gratissimum (Lamiaceae), Calendula officinalis (Asteraceae), and Centella asiatica (Apiaceae) although C. officinalis is native to Southern Europe, and C. asiatica an Asian-native; they are widely used in African traditional medicine and included here for their relevance in African wound healing practices; Justicia flava (Acanthaceae), Alternanthera sessilis (Amaranthaceae), and Acalypha indica (Euphorbiaceae); play key roles in enhancing collagen production, angiogenesis, and re-epithelialisation. This comprehensive analysis highlights the role of African medicinal plants in wound healing and their potential to improve wound care therapy.

This scoping review investigates the use of point-of-care infrared thermography devices for assessing various wound types. A comprehensive search across four databases yielded 76 studies published between 2010 and 2024 that met the inclusion criteria. The review highlights thermography applications in burns, surgical wounds, diabetic foot ulcers, pressure injuries, and other lower limb wounds. Key findings indicate its effectiveness in detecting early signs of inflammation and healing delays, facilitating timely interventions. The technology shows promise in accurately predicting wound healing trajectories and assessing treatment outcomes. Recent advancements have made thermographic devices more affordable and user-friendly, expanding their clinical potential. However, challenges persist, including reimbursement, training requirements, and integration with electronic medical records (EMRs), with EMR integration identified as a critical barrier to widespread adoption. While preliminary findings are promising, the current evidence base is constrained by small sample sizes, retrospective study designs, and limited consideration of skin tone variability. Large, prospective studies are essential to validate the clinical utility of thermography in wound care and to inform the development of standardised protocols that support equitable, bias-reduced assessment across diverse populations. Addressing these gaps is critical for advancing research, enhancing clinician training, and improving patient outcomes in wound care. Overall, point-of-care thermography demonstrates significant potential to enhance wound assessment and monitoring, thereby elevating care quality and patient outcomes.

This study aimed to investigate the current status and associated factors related to theoretical competence, practical competence and attitudes towards chronic wound care among wound, ostomy and continence (WOC) nurses in China. A questionnaire survey was conducted to assess theoretical competence and attitudes, while simulations were conducted to evaluate practical competence separately. A total of 355 WOC nurses were recruited from 22 provinces, autonomous regions and municipalities across mainland China using a convenience sampling method. The study instrument was translated and adapted into a Chinese translation of the C/WoundComp instrument. A total of 351 valid questionnaires were collected, with 17 participants completing the practical competence test. The mean scores for theoretical competence, practical competence and attitude were 30.16 ± 3.84, 10.24 ± 1.44 and 23.42 ± 2.76, respectively. Multivariate linear regression analysis revealed that certification and having received post-degree wound care training within the past 2 years were the primary factors influencing WOC nurses' theoretical competence in chronic wound care. Additionally, certification and education level were the primary factors influencing WOC nurses' attitudes towards chronic wound care. Although WOC nurses demonstrated a positive attitude towards chronic wound care, their theoretical and practical competence needs improvement. This study provides evidence to inform revisions to current training content, continuing education and recertification processes for WOC nurses in China.

To investigate the impact of nurses' occupational fatigue and exhaustion levels on their self-efficacy in managing pressure injuries. A descriptive cross-sectional study. The data were collected from 682 nurses employed at three institutions from May 15 to July 31, 2023. Occupational fatigue and exhaustion were assessed using the OFER scale, while self-efficacy in pressure injury (PI) management was evaluated using the PUM-SES. Correlation and multiple linear regression methods were used for data analysis. The STROBE checklist was used in the study. The study included 682 nurses, 85.3% female. The average age was 29.99 years, with a mean work experience of 7.52 years. Most participants (70.7%) worked in public training and research hospitals, with 327 nurses working mixed day-night shifts and 358 nurses managing 1–5 patients per shift. Fatigue levels, measured using the OFER, showed a mean score of 67.54 (22.89) for chronic fatigue. Self-efficacy in pressure ulcer management, assessed using the PUMSES, had a mean score of 48.39 (24.87). Higher PUMSES scores were found among nurses with certification in stoma and wound care (p < 0.001) and those who had attended relevant training (p < 0.001). Significant correlations were identified between OFER recovery scores, professional characteristics and PUMSES scores. This study revealed that nurses experience moderate-to-high levels of occupational fatigue and low levels of self-efficacy in PI management. Although no significant relationship was found between fatigue and self-efficacy, occupational factors such as poor sleep quality, long working hours and irregular shift patterns were associated with increased fatigue. In contrast, higher educational attainment, greater knowledge about PI and participation in professional training significantly enhanced nurses' self-efficacy in PI management. This study offers some early data on the possible role of occupational fatigue and PI preventive practices.

We sincerely thank Tan and Wang [1] for their valuable comments on a recent study evaluating the role of Hyperbaric Oxygen Therapy (HBOT) in graft reconstruction of diabetic foot wounds [2]. We welcome the opportunity to clarify several important points regarding the methodology and findings.

First, to address the authors' emphasis on selection bias and heterogeneity in the control group, we agree that retrospective designs inherently limit randomisation. However, the patient grouping reflects real-life clinical practice. HBOT was administered to patients with vascular insufficiency, osteomyelitis and/or advanced Wagner stages, that is, those with a clinical indication. Patients in the control group were either not indicated for HBOT or had absolute (e.g., untreated pneumothorax) or relative contraindications (e.g., claustrophobia, pulmonary blebs or bullae).

Despite this initial clinical imbalance, the HBOT group showed a significantly shorter time to 50% wound healing (18 days vs. 30.5 days, p < 0.05). Furthermore, in patients who underwent successful vascular intervention, the graft uptake rate was significantly higher in the HBOT group (100% vs. 80%, p = 0.037). These results support that HBOT can offset poor clinical baseline status and improve outcomes even in more complex cases.

Another important topic of discussion is the evaluation of 50% healing time as a clinical endpoint. Although 50% healing time is not a “hard” endpoint like amputation or reoperation, it is a practical and meaningful marker of the wound healing process. A review of the literature shows that early epithelialisation reduces the risk of infection, hospitalisation and limb loss [3, 4]. In the aforementioned study, a significant negative correlation was found between graft uptake rate and healing time (r = −0.418, p < 0.05), indicating that faster healing is associated with better graft outcomes.

In the clinical setting described, HBOT was recommended to patients in the HBOT group because of vascular insufficiency, infection, or delayed wound healing in the pre-grafting period. After multidisciplinary evaluation, some patients continued to receive HBOT after grafting. However, given that each patient was evaluated individually and the retrospective design of the study, it was not possible to apply the same number of HBOT sessions in all patients in the pre- and postoperative periods in a standardised manner.

HBOT has been used in the preoperative period to support granulation tissue formation, increase wound healing, reduce edema, and suppress infection. In the postoperative period, it increased oxygenation and accelerated tissue regeneration. This reflects the holistic and integrated application of HBOT in the treatment process.

It is agreed that prospective, randomised studies with larger samples are necessary to ensure the generalisability of the results. Ne