International Wound Journal最新文献

Wound care in calciphylaxis remains poorly defined without evidence-based consensus on timing and technique of surgical intervention. We demonstrate that surgical debridement and subsequent wound closure are safe and effective in calciphylaxis and describe a systematic multidisciplinary approach to intervention. We retrospectively reviewed a cohort of patients with calciphylaxis at our institution. Those who underwent surgical debridement and wound closure were analysed with emphasis on wound healing, progression to amputation and mortality. Sixty-two patients with calciphylaxis underwent surgical debridement. Twenty patients had wound closure by skin grafting, five were excised with primary wound closure, and 37 were debrided and allowed to heal by secondary intention. There were excellent rates of healing in all groups, and no patients demonstrated wound progression or new lesions following operative intervention. Surgical debridement and wound closure are safe and effective in treating wounds related to calciphylaxis.

Diabetes related foot ulcers (DFU) are associated with significant physical, psychological and social dysfunction. Measuring the impact of treatments on patients' overall well-being is vital to ensure care is holistic. This study aimed to validate the Wound-Qol-14 quality of life assessment tool in people with a DFU. A single centre longitudinal prospective validation study in people with DFUs was conducted. Wound-Qol-14, Diabetic Foot Ulcer Scale-Short Form (DFS-SF) and EuroQol 5 dimensions 5 levels (EQ-5D-5L) were completed by people with DFUs at baseline and 6 months. Wound-Qol-14 was repeated within 7 days of the first questionnaire. Correlation coefficients with a cut off of ≥ 0.7 were used to assess convergent validity, divergent validity and responsiveness to changes in DFU severity. Reliability was assessed using Cronbach's α. The study aimed to recruit 100 people. One hundred and seven people were recruited. The mean age was 62 (SD 13) years and 85 (79.4%) were male. The mean DFU duration was 30 (SD 83) days and the mean DFU area was 6.2 (SD 10.7) cm². Convergent validity was demonstrated in all domains of Wound-Qol-14 and DFS-SF (r - 0.695 to -0.799) except burden/bothered about ulcer care domains (r = -0.443). There was moderate correlation between Wound-Qol-14 domains and EQ-5D-5L dimensions (r = 0.477-0.501). Cronbach's α ranged from 0.683 to 0.919 for the domains of Wound-Qol-14. Wound-Qol-14 was not responsive to changes in DFU severity (r = -0.291; 95% CI -0.501 to -0.048) but was responsive to healing status (healed 1.14 [IQR 0.86] vs. unhealed 1.86 [IQR 1.47]; p = 0.017). Wound-Qol-14 is a valid and reliable tool to measure disease-specific quality of life in people with DFUs. Further work is needed to refine the responsiveness. EQ-5D-5L should be used to measure generic quality of life in people with DFUs.

The 'Wound Hygiene Italia' project was designed to provide expert-driven recommendations for the assessment, management and monitoring of venous leg ulcers, tailored to diverse settings of care (hospital, ambulatory and home care). The recommendations, developed by a multidisciplinary panel, emphasise the implementation of the Wound Hygiene strategy, a systematic approach targeting biofilm as a primary barrier to wound healing. Wound management is structured around four steps: cleansing, debridement, edge refashioning and dressing selection adapted to the wound bed characteristics, care setting and clinical capabilities, embedded in a holistic approach through comprehensive patient assessment and monitoring of overall well-being. The findings highlight the necessity of interdisciplinary collaboration, standardised tools and continuous patient monitoring, as assessed by objective metrics, such as wound size measurements and photographic documentation. Effective communication with patients and caregivers is also essential to ensure treatment adherence and foster trust in the care process. This framework integrates evidence-based practices to optimise outcomes and patient quality of life. By addressing both clinical and psychosocial factors, the recommendations promote a holistic, patient-centred approach that underscores the importance of education, structured follow-ups and tailored interventions.

This study evaluated the frictional properties of the skin-contact interfaces of two multilayer prophylactic dressings under simulated perspiration conditions. The tested dressings were identical except for the skin-contact interface, which was either silicone-made or Hydrofiber-made, that is, AQUACEL Hydrofiber Technology. Using a standardised tribological 'sled test' setup and a skin-mimicking polymer substrate, we measured the static and kinetic coefficients of friction for each dressing interface type at varying moisture levels. The dressing with the Hydrofiber interface consistently demonstrated significantly lower static and kinetic coefficients of friction compared to the silicone-based dressing, across all moisture conditions. The Hydrofiber interface exhibited a sharp coefficient of friction reduction with minimal (5%) moisture accumulation, mimicking overnight perspiration under thermoneutral conditions. This dressing maintained the low coefficient of friction levels at a steady level of approximately 0.2 until full saturation. In contrast, the silicone interface retained high (> 1) coefficients of friction regardless of moisture. These findings highlight an important biomechanical advantage of Hydrofiber skin-contact materials in reducing frictional forces at the skin-dressing interface, especially in moisture-prone body areas, in a pressure injury prevention context. Friction-responsive skin-contacting dressing materials with low coefficients of friction, which remain low while they become moist due to perspiration accumulation, should be preferred for preventative dressings.

Understanding the patient perspective is crucial for enhancing healthcare delivery and outcomes for chronic conditions like diabetic foot ulcers. This qualitative study examined the perspectives of patients with diabetic foot ulcers to inform clinical strategies for both physicians and current patients to enhance care and prevent lower extremity amputations. Fifteen patients with a history of diabetes and diabetic foot ulcers and/or amputations participated in semi-structured interviews which explored their lived experiences and advice for both physicians and fellow patients to improve diabetic foot ulcer related care. Interview transcriptions were analysed to identify recurring themes. Advice for physicians emphasised increasing patient education, initiating preventive foot care at the time of diabetes diagnosis, providing instructions for managing diabetic ulcers early and demonstrating empathetic bedside manner. Advice for fellow patients focused on adopting healthy lifestyle practices, regular foot self-examinations, consistent blood glucose monitoring, medication adherence and seeking prompt medical attention for new or worsening foot lesions. Participants also stressed the importance of routine check-ups with providers to support prevention and management efforts. This qualitative study highlights the value of incorporating patient perspectives to improve our understanding of diabetic foot ulcer onset, care and outcomes and thereby reduce the risk of lower extremity complications.

Necrotising soft tissue infection (NSTI) is a progressive disease with a time-dependent prognosis; if not promptly treated, it can lead to significant morbidity as well as mortality. Early and aggressive surgical treatment is mandatory for appropriate management. This study reports the diagnostic and therapeutic pathway, surgical treatment and outcomes in a single-centre series. Data from 40 patients with NSTI treated between 2015 and 2024 were retrospectively analysed for demographic and social information, microbiological results, therapeutic course, clinical outcome and mortality. TC Indication and timing, the role of limb amputation in critical patient survival and reconstruction technique were also reviewed. Fourteen patients (35%) were referred at an advanced stage due to avoidable delay. The mean number of surgical interventions for a single patient was 4. Eight patients (20%) underwent limb amputation. Skin grafts were the most used reconstruction procedure. Seven patients (17.5%) died in the hospitalisation. NSTI is a life-threatening disease requiring prompt diagnosis and treatment within dedicated clinical pathways. Our series highlights the fundamental role of TC in critical patients or unclear diagnosis, and limb amputation as a life-saving procedure even at admission in severe cases.

Peripheral intravenous catheters (PIVCs) are widely used in hospital settings but are associated with high failure rates and patient safety risks. Various dressing and securement methods have been implemented to mitigate these complications. This systematic review aimed to systematically review the effectiveness and safety of different dressing and securement methods for PIVCs in hospitalised adult and paediatric patients. Randomised controlled trials (RCTs) published between 1959 and 2024 were identified through searches of CENTRAL, CINAHL, Ovid EMBASE, and Ovid MEDLINE. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using GRADE. Outcomes included PIVC failure, dislodgement, occlusion, infiltration, extravasation, phlebitis, and catheter-related bloodstream infection (CRBSI), analysed using risk ratios where meta-analysis was feasible. Dwell time was reported descriptively as mean or median values. Fifteen RCTs involving 5542 participants evaluated eight PIVC dressing and securement methods. In adult populations, tissue adhesive significantly reduced PIVC failure compared with transparent polyurethane dressing (risk ratio [RR] 0.83, 95% confidence interval [CI] 0.73-0.95), as well as dislodgement (RR 0.60, 95% CI 0.42-0.84) and occlusion (RR 0.73, 95% CI 0.57-0.94). Transparent polyurethane dressing was associated with lower dislodgement rates compared with gauze in adults. Other comparisons showed no statistically significant differences or were informed by single studies only, limiting the strength of conclusions. Evidence in paediatric populations was sparse and predominantly derived from individual trials. Tissue adhesive appears effective in reducing PIVC failure and mechanical complications in adults. Its effectiveness in pediatric patients remains uncertain, highlighting the need for further adequately powered trials.

To measure and compare the temporal variations in sub-bandage pressure compression systems in the Andalusian Health System (SAS). Additional objectives included assessing the relationship between pressure and healing, analysing the influence of the healthcare professional applying the bandage, and determining bandage stiffness. This prospective observational and multicentre study included 140 patients with active VLUs in Andalusia. Sub-bandage pressures were measured at three anatomical points in the leg for 96 h, under different positions and activities. The bandage application technique was standardised through specific training provided to advanced practice nurses. The initial pressures were higher than those recommended by guidelines, but showed a notable reduction within the first 24 h, stabilising within therapeutic ranges for the remainder of the 96-h study period. Most systems showed low dynamic and static stiffness. No significant pressure differences were found attributable to the nurses or the location of the injury. The observed pressure dynamics, initially high, with a subsequent drop and final stabilisation, suggest a high material settlement or application to compensate for the expected loss. The sustained pressure stability confirms the effectiveness of the systems over 96 h.

Negative-pressure wound therapy (NPWT) is widely used in clinical practise to enhance wound healing; however, its biological effects on intact skin remain poorly understood. Given the expanding applications of NPWT, understanding its impact beyond open wounds is increasingly important. This study aimed to evaluate the biological responses of intact skin to negative-pressure, specifically focusing on epithelial-mesenchymal transition (EMT). The effects of negative-pressure loading were assessed using an in vitro model of non-diabetic human keratinocytes and an in vivo model of intact diabetic mouse skin. Human keratinocytes exposed to negative-pressure exhibited increased expression of thrombospondin-1 (THBS1), transforming growth factor-beta 1 (TGF-β1), plasminogen activator inhibitor-1 (PAI-1), and hypoxia-inducible factor 1-alpha (HIF-1α), alongside decreased epithelial markers and increased mesenchymal markers. These EMT-related changes were mitigated by inhibiting the THBS1-TGF-β1 interaction. Similarly, in diabetic mice, intermittent negative-pressure loading applied to intact dorsal skin significantly increased THBS1 and TGF-β1 levels, resulting in epidermal and dermal thickening, and promoted hypoxic, prothrombotic and angiogenic responses, as evidenced by increased HIF-1α, PAI-1, fibrinogen and vascular endothelial growth factor expression. These findings suggest that negative-pressure loading can induce EMT-like responses and tissue remodelling in intact skin primarily via mechanisms involving the THBS1-TGF-β1 signalling axis. This study expands the understanding of the biological influence of NPWT beyond traditional wound treatment applications, potentially informing future therapeutic considerations and safety guidelines.

The financial burden of diabetes-related foot disease (DFD) in Australia remains inadequately understood. This study aimed to explore the direct costs and resource utilisation associated with DFD management, incorporating insights from healthcare professionals actively involved in the treatment of individuals with DFD. A three-step approach informed the economic evaluation. First, a systematic review identified existing Australian cost data. Second, semi-structured interviews with healthcare professionals generated estimates of resource utilisation and addressed data source gaps. Third, a Markov model evaluated the costs of DFD management at both the individual and health system levels. The model included direct costs related to hospital admissions, outpatient/community visits, medications, diagnostics, wound care, offloading devices and amputation-related expenses. The average annual cost per patient for DFD management was AUD $44 691. The primary cost drivers were hospital admissions ($21 566), outpatient/community visits ($14 212) and wound debridement ($5918). The total cost to the Australian healthcare system in 2026 is estimated at AUD $3.08 billion, with projections reaching AUD $3.81 billion by 2030. This study provides essential cost estimates for DFD management at both the individual and health system levels, offering critical insights for policymakers seeking to optimise service delivery and improve patient outcomes in Australia.