International Wound Journal最新文献

This study investigated the efficacy and safety of a novel thermo-reversible antimicrobial wound gel (TRG, revyve Antimicrobial Wound Gel) designed to combat biofilm-related infections in wounds. The TRG was evaluated for its ability to disrupt biofilms, sustain antimicrobial activity and promote wound healing. The gel exhibited thermo-reversible properties, transitioning from a less viscous liquid ≤ 18°C to a highly viscous solid gel at wound temperature which would facilitate easy application and removal. Antimicrobial testing demonstrated that TRG effectively inactivated a broad range of wound-related pathogens, including Staphylococcus aureus and Pseudomonas aeruginosa, with a 99.99%–99.9999% reduction in bacterial counts within 30 min. The TRG also maintained its antimicrobial efficacy after multiple inoculations with high microbial load (10⁷ CFU/mL) over 7 days. In vitro biofilm assays showed effectiveness against biofilm bacteria with a reduction of ≥ 99.99% bacterial counts with one application over the course of 7 days. Biocompatibility testing confirmed that TRG was safe, with no signs of tissue necrosis or signs of tissue damage and no impact on wound healing in a porcine wound model. TRG's ability to reduce both planktonic and biofilm-based bacteria without compromising wound healing makes it a promising candidate for treating both chronic and acute wounds.

This retrospective study aimed to evaluate the clinical efficacy of double flap tibial transverse transport (dTTT) in the treatment of Wagner grade 3–4 diabetic foot ulcers (DFUs) and to assess its impact on peripheral nerve function in the affected limb. A total of 25 patients with DFUs who underwent dTTT at our institution were included. Baseline data were collected, and patients were systematically followed at 1, 3, 6 and 12 months postoperatively. Primary outcome measures included wound healing status, postoperative complications, microcirculatory indicators and nerve conduction parameters. All bone transport sites healed successfully, with no major complications observed except for one patient who died from COVID-19. At 12 months postoperatively, significant improvements were noted in foot skin temperature, transcutaneous oxygen partial pressure and the ankle-brachial index (all p < 0.001). Additionally, motor nerve conduction velocities of the posterior tibial and common peroneal nerves increased significantly (p < 0.001), and corresponding compound muscle action potential amplitudes rose to 4.91 ± 0.14 mV and 4.68 ± 0.29 mV, respectively (p < 0.001). These findings suggest that dTTT not only facilitates wound healing by improving local microcirculation but also enhances peripheral nerve function, offering a promising therapeutic approach for improving long-term outcomes and quality of life in patients with advanced DFUs.

Skin tears (ST) are common traumatic wounds, particularly among older adults, that can lead to complications if not accurately assessed and classified. The International Skin Tear Advisory Panel (ISTAP) classification system is widely used internationally; however, no validated Persian version currently exists. To culturally adapt, and evaluate the clinimetric properties of the Persian version of the ISTAP Classification System. This methodological study was conducted from February to May 2025 in multiple phases. After forward–backward translation and expert review, face and content validity were assessed. Criterion validity was assessed by comparing nurses' classifications with expert consensus using weighted Cohen's kappa coefficient. Construct validity was examined using the known-groups method, comparing skin tear frequency and severity between 30 elderly patients with impaired mobility and 30 younger adults without impaired mobility. Reliability was evaluated using Fleiss' kappa coefficient for multiple raters, and weighted Cohen's kappa coefficient for inter-rater and intra-rater agreement. Diagnostic accuracy indices, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR–), odds ratio (OR) and the area under the receiver operating characteristic curve (AUC), were calculated for each skin tear type. Content validity was excellent (content validity ratio (CVR): 0.82–1.00; item-level content validity index (I-CVI): 0.91–1.00; scale-level content validity index (S-CVI/Ave): 0.94). Criterion validity showed almost perfect agreement with experts (weighted κ = 0.902, p < 0.001). Construct validity was supported by significant group differences in skin tear frequency (Fisher's exact p = 0.001) and severity (t(58) = 2.12, p = 0.039). Reliability was substantial to almost perfect across analyses (Fleiss' κ = 0.8447; inter-rater weighted κ = 0.66; intra-rater weighted κ = 0.86). Diagnostic accuracy was excellent for all types (AUC = 0.99), with sensitivity 97.5%–99.2%, specificity 98.4%–99.6%, PPV 97.5%–99.3%, NPV 98.1%–99.6% and very high OR and LR values. The Persian version of the ISTAP Classification System demonstrated excellent validity, reliability and diagnostic accuracy, supporting its use as a standardised tool for assessing ST in Persian-speaking healthcare settings.

Skin failure is increasingly recognised across healthcare settings, yet its definition, diagnostic criteria and relationship to pressure injuries remain inconsistent with little interdisciplinary consensus. This lack of clarity complicates bedside assessment, documentation and quality reporting. Historically, pressure injuries were viewed as preventable events associated with inadequate care, but growing evidence shows that some wounds develop despite optimal preventive measures, particularly in patients with multimorbidity or limited physiological reserve. This article will review the historical development of skin failure and how it is intertwined with contrasting theories of pressure injury formation that began in the 19th century. We will track the proliferation of definitions and overlapping terms that muddle contemporary documentation and classification, and demonstrate why a unified definition is urgently needed. Skin failure represents the intersection of tissue deformation with systemic vulnerability including hypoperfusion, inflammation, vascular dysfunction, oedema, medication effects, immune compromise, nutritional depletion and age-related changes. A meaningful and practical definition must span all healthcare environments and patient populations, supporting accurate diagnosis and equitable evaluation of care quality. We outline a call to action that includes interdisciplinary consensus, standardised terminology and the development of predictive tools that integrate physiologic data, advanced analytics, and patient-centered outcomes across the healthcare continuum.

Surgical site infections (SSI) in vascular surgery have a huge impact on patients’ morbidity and mortality and healthcare systems worldwide. Dialkylcarbamoylchoride (DACC) is a synthetically produced material that can irreversibly bind and inactivate bacteria that exhibit cell-surface hydrophobicity (CSH). The DACC in the Reduction of Surgical Site Infection (DRESSINg) trial is a multicentre randomised controlled trial which aims to assess the effectiveness of DACC-coated post-operative dressings in the prevention of SSI in vascular surgery. Seven hundred and eighteen participants undergoing clean or clean-contaminated lower limb vascular surgery will be randomised in a 1:1 ratio to either DACC-coated dressings or standard dressings for their postoperative wounds. The primary outcome is the incidence of SSI defined by the Centers for Disease Control and Prevention (CDC) criteria or total ASEPSIS score of 21 or more within 30 days of surgery. The secondary outcomes include satisfactory wound healing with a total ASEPSIS score of 10 or less, quality of life pre and post surgery, Bluebelle wound healing scores, resource use and financial (£), and environmental (KgCO2e) cost analyses. This multicentre randomised controlled trial will provide level 1 evidence on the effectiveness of preventing SSI in lower limb vascular surgery.

Effective thermal management at the skin-dressing interface is essential in pressure injury prevention by means of prophylactic dressings. This study quantified the thermal conductivity of AQUACEL Hydrofiber Technology (AHT, hydrofiber) and polyurethane foam dressing materials under normothermic (32°C) and febrile (40°C) conditions across increasing moisture levels. Using a validated custom heat-flow meter system, dry hydrofiber exhibited significantly greater thermal conductivity than the polyurethane foam (0.43 ± 0.01 vs. 0.20 ± 0.01 W/m K at 32°C; p < 0.001). Upon hydration at 32°C, thermal conductivity values increased nonlinearly for both materials but to a much greater extent for the hydrofiber. At 15% moisture, the hydrofiber reached 4.73 ± 0.12 W/m K compared to the polyurethane foam at 1.03 ± 0.02 W/m K. At 40°C, hydrofiber achieved 3.39 ± 0.19 W/m K with only 10% moisture, indicating a temperature-responsive biphasic transformation. Overall, hydrofiber demonstrated a fivefold greater thermal conductivity response to moisture than the polyurethane foam. These findings highlight critical, material-dependent differences in heat dissipation under clinically relevant conditions. The superior moisture-responsive thermal conductivity of hydrofiber highlights its potential to improve heat dissipation at the skin-dressing interface under clinically relevant conditions and thereby mitigate local heat accumulation, contributing to skin protection. Thermal conductivity and thermal adaptability studies should be integrated into dressing efficacy research and be used for selection criteria for pressure injury prevention programs alongside mechanical and absorptive performance.

The aim of this study was to develop a predictive model of nutritional risk in elderly CAPI patients through retrospective cross-sectional data, to identify core predictors applicable to community/nursing home settings, and to validate the predictive augmentation of the combined Braden Score and Nutritional Blood Indicator in hospitalised patients, to provide a basis for stratified nutritional risk management. A retrospective study was conducted to include 424 elderly CAPI patients. They were divided into two groups according to NRS2002 score. Demographic parameters, physiological function parameters and blood parameters were collected. All above indicators of the patients with CAPI were analysed to explore their correlation with nutritional risk. Among 424 participants, 294 patients (69.34%) were at nutritional risk. Independent risk factors identified were aged ≥ 70 years, reduced intake in the last week, and decrease in BMI, Braden score, ALB (albumin), and PA (prealbumin) levels. The AUCs of the first four parameters mentioned above and all the above parameters were 0.816 and 0.872, respectively. The value of aged ≥ 70 years, reduced intake in the past week, BMI, and Braden score in combination to predict and assess nutritional risk is high, which can be used to predict nutritional risk for elderly patients with CAPI who are at home or in nursing homes. The combination of the above parameters combined with albumin and prealbumin has an even higher predictive value in elderly patients hospitalised with CAPI.

Pressure injuries present significant challenges in clinical care, leading to severe complications such as infection, pain and delayed wound healing. They are a common chronic wound that contribute to increased morbidity, prolonged hospital stays and substantial healthcare costs. Despite national efforts to enhance chronic wound management, development of optimal treatment strategies remains a priority. The Pressure Injury Treatment Advisory (PITA) Quick Guide was developed to provide an evidence-based guide to support clinicians in pressure injury management. A survey was conducted to evaluate clinician perspectives on the usability and practicality of the Guide in acute care, residential aged care and community settings. A post-test survey was conducted on a convenience sample of healthcare professionals from three healthcare settings across metropolitan, regional and rural Australia. The survey included 5-point Likert-scale items assessing ease of use, effectiveness and integration with workflows. Three hundred and two responses were received (66.7% response rate). Clinicians expressed overwhelmingly positive perceptions, with over 95% agreeing or strongly agreeing on the guide's utility and effectiveness. No respondents strongly disagreed with any item. Residential aged care and rural clinicians rated the tool slightly higher than acute care and medical clinicians. The PITA Quick Guide was well-received across all settings, demonstrating strong potential to enhance evidence-based pressure injury management.

Compression therapy is the cornerstone, first-line effective evidence-based treatment for healing and managing venous leg ulcers. However, compression therapy is inconsistently applied in hospitals. This paper explores the experiences of a diverse group of clinicians and senior managers applying compression therapy in hospitals across the United Kingdom. A semi-structured qualitative interview study was conducted with 19 participants, drawn from a larger study, who confirmed that their respective hospitals apply compression therapy to inpatients with venous leg ulcers. The interviews were analysed using reflexive thematic analysis. Analysis generated four key themes: Patients ‘slip through the net’, Prioritisation in Hospital Care, A ‘blind Spot’ within Healthcare System and Motivation to Deliver Care. Patients ‘slip through the net’ refers to inpatients with venous leg ulcers face unequal access to compression therapy both within and between hospitals. Prioritisation in Hospital Care indicates how certain diseases are given greater emphasis within healthcare systems. A ‘blind Spot’ in Healthcare System described failing to implement compression therapy has created a critical underlying ‘blind spot’ within the NHS healthcare systems. Motivation to Deliver Care refers to a deep commitment to providing compression therapy, driven by clinicians' inherent dedication and ethical obligation towards improving patient quality of care. The study identified key challenges influencing the application of compression therapy in acute hospitals despite its routine use. These include the lottery of care, systemic inequities, unclear ownership, interprofessional disputes and organisational priorities. It also demonstrated the significant role of passion, motivation and moral responsibility encouraging clinicians to implement compression therapy despite these systemic barriers.