International Wound Journal最新文献

Necrotising fasciitis (NF) is a rapidly progressing, life-threatening infection with mortality rates that are exceedingly high. Despite the notably high risks of developing NF in patients with diabetes mellitus (DM), factors associated with mortality in this population are poorly understood. Therefore, to determine at-risk patients and to improve overall clinical outcomes via hastening management, the objective of this systematic review is to determine what factors are associated with mortality for diabetic patients with NF. This systematic review followed the PRISMA guidelines. Patient data pertaining to outcomes and surgical management were extracted, and mortality rates were evaluated. Studies were assessed for quality using the Alberta Heritage Foundation for Medical Research (AHFMR) and Risk of Bias tool. A total of 25 studies were reviewed, covering 7879 patients with NF and DM with a 23.5% mortality rate. The most prevalent comorbidities among those who died included chronic kidney disease (15.95%), hypertension (9.42%) and obesity (9.02%). While limbs were the most common location for the disease, NF in the trunk and groin regions showed the highest mortality rates at 62.07%. Among those who died, common complications were acute renal failure (13.41%), pulmonary issues (20.41%) and septicaemia (12.80%). Mortality rates by surgical management were fasciotomy (42.9%), surgical debridement (40.68%) and amputation (9.09%). Mortality was comparable between patients with NF and DM (23.54%) and those with NF alone (23.61%). Although DM may not independently increase mortality, it can worsen outcomes when combined with other comorbidities, indicating a need for clearer clinical guidance.

Diabetes is a leading cause of morbidity and mortality, contributing to complications such as cardiovascular disease, kidney failure and lower-limb amputations. Diabetic foot complications, such as structural deformities, ulceration and infection, present significant risks, necessitating early detection and intervention. This study explores the development and validation of artificial intelligence (AI) image analysis for diabetic foot screening, focusing on structural deformity identification which includes callus, hallux valgus and hammer toes, because they represent the earliest detectable visual risk markers for ulceration, preceding wound formation. Leveraging datasets comprising over 1000 healthy foot images and 215 diabetic foot deformity images, the model employed YOLOv5 for object detection, a convolutional autoencoder for anomaly detection, and DenseNet201 for anomaly classification. Initial internal validation yielded 91.1% anomaly detection accuracy, while anomaly classification accuracy improved to 88.57% following refinement. External validation using 27 participants achieved an overall accuracy of 85.2% and anomaly classification accuracy of 66.7%. Final evaluation on 35 unlabelled images demonstrated promising performance, with 88.57% accuracy, 90.47% precision and an F1 score of 86.11%. Integrated into the ‘Foot at Risk’ (FAR) mobile application, this AI-driven solution offers a scalable tool for early diabetic foot deformity detection. With larger dataset input for training and development, it can be utilised as an early screening tool for diabetic foot and integrated into existing community diabetic care model, facilitating timely intervention and improving patient outcomes.

Preventing pressure injuries among nursing home residents is a significant challenge that necessitates understanding the barriers and facilitators from the perspective of staff. This qualitative study aimed to describe these factors within Sri Lankan nursing homes. Semi-structured interviews were conducted with 15 nursing home staff members from nine nursing homes in and near the Colombo district, Sri Lanka. The study was informed by the capability, opportunity, motivation, and behaviour model that guided both data collection and analysis. Data were analysed using content analysis. Using deductive coding based on capability, opportunity, and motivation, followed by inductive analysis, four primary categories emerged: focusing on skincare is foundational for pressure injury prevention, pressure injury knowledge is critical for prevention, pressure injury prevention is a low organisational priority, and overcoming challenges to enact pressure injury prevention. Key facilitators included access to skincare products, maintaining clean and dry skin, recognising risk factors, proactively managing risks, and understanding the broader implications of pressure injuries on residents and their families. Conversely, barriers encompassed limited training, varying staff support, inadequate resources, and the complexities of managing multiple tasks. This research highlights that enhancing knowledge and allocating resources effectively can improve the implementation of pressure injury prevention strategies in Sri Lankan nursing homes.

Open femoral vessel access is commonly performed in vascular surgery, but surgical site complications (SSCs) occur frequently. The aim of this study is to evaluate the incidence and identify potential risk factors by applying a new standardised definition and grading of various types of groin wound complications. This retrospective analysis includes 201 consecutive patients with 219 vertical groin incisions to expose the femoral vessels for different vascular interventions. A prophylactic drain was placed intraoperatively in almost all incisions (91%). Groin SSCs were defined and graded into four categories according to a modified Clavien-Dindo classification. Potential risk factors were evaluated using univariable analysis. For multivariable analysis, a multiple logistic regression was performed. Cutoff values were determined through ROC analysis. According to the proposed definition, regular postoperative course grade 0 (no SSC) occurred in 163 patients (74.4%), grade 1 (minor SSC) in 10 (4.6%), grade 2 (moderate SSC) in 14 (6.4%), and grade 3/4 (major or life-threatening SSC) in 32 (14.6%) incisions. The incidence of clinically relevant SSCs (grade 2–4) was 21%. Drainage volume was an independent parameter that predicted relevant SSCs with a threshold value of 70 mL/24 h on postoperative day 4 (sensitivity 100%; specificity 67%; AUC = 0.835; p = 0.0004). Groin wound complications following vascular procedures are common. Lymphatic leakage appears to be the most significant, potentially preventable condition associated with relevant SSCs. Prophylactic or early therapeutic interventions should focus on reducing lymphatic morbidity.

Near infrared (NIR) therapy is increasingly used to enhance postoperative wound healing, yet clinical trial results remain inconsistent. To evaluate the effectiveness of NIR therapy on postoperative wound healing and identify treatment parameters associated with optimal outcomes: This systematic review and meta-analysis registered at PROSPERO (CRD420251163415) assessed evidence on comparing NIR therapy (630–1100 nm) with standard care or placebo on healing of surgical-induced wounds. A multilevel random-effects meta-analysis of standardised mean differences (SMDs) was conducted. Moderator analyses examined the wavelength, fluence, session number, application technique and anatomical site. Risk of bias was assessed using Cochrane RoB 2.0 and certainty of evidence was rated with GRADE. Fifty-six trials (N = 4920) were included for systematic review and 35 trials contributed 69 outcomes to meta-analysis. NIR significantly improved wound healing (0.78, [0.46–1.09], p < 0.01) and reduced postoperative pain (0.71, [0.24–1.17], p < 0.01), but heterogeneity was high and effects varied across studies. Optimal outcomes were associated with short NIR wavelengths (700–850 nm), 4–10 sessions and non-contact application. Effects on swelling, scarring and inflammatory markers were inconsistent. Overall, certainty of evidence was very low. This first systematic review and meta-analysis indicates that NIR therapy demonstrates promise for enhancing postoperative healing and reducing pain, though effects vary by protocols.

Although topical oxygen therapy (TOT) is a promising treatment for chronic wounds, its clinical efficacy and safety remain to be rigorously established. We conducted a two-arm randomised controlled trial to evaluate the efficacy and safety of TOT for treating chronic wounds by a commercially available portable continuous diffusion of oxygen (CDO) system. Eighty-eight patients were allocated to the TOT (n = 44) or moist wound therapy (MWT) (n = 44) group for a 28-day intervention period, followed by standardised MWT for unhealed wounds until the 12-week endpoint. Eighty-eight patients were allocated to either the TOT group (n = 44) or the standard MWT group (n = 44) for 28 days (or until wound closure) and were followed for up to 12 weeks. Wound area, depth, pH, healing rate and healing time were assessed weekly for 28 days or until 12 weeks. Any adverse event was observed at the same time. At day 28, the TOT group demonstrated significantly greater reductions in wound area and depth compared with the MWT group (p < 0.05). The wound bed pH in the TOT group was lower than the MWT group at day 14 and 28. Although the healing rate was higher in the TOT group than in the MWT group at day 28 (45.5% vs. 11.4%, p < 0.001), the healing rate in both groups was similar at week 12 (95.5% vs. 90.9%, p = 0.536). The healing time of the TOT group was shorter than that of the MWT group at week 12 by 13.5 days (95% CI: 6.74–15.40; p = 0.004). No TOT-related adverse events were reported. These findings indicate that portable TOT can significantly accelerate wound healing, particularly by improving wound bed pH that could facilitate subsequent healing processes in patients with chronic wounds.

Burn injuries are a significant cause of morbidity and mortality globally; however, limited data are available from low- and middle-income countries such as Jordan. This study aimed to describe burn patient presentation, initial management and factors associated with in-hospital mortality. A retrospective descriptive study was conducted using records of 493 patients admitted to a national referral centre in Jordan between 2018 and 2022. The sample was predominantly male (61.5%) with a mean age of 19.6 years (SD = 21); children under 18 years comprised 58.4%. The mean total body surface area (TBSA) burned was 18%. Flame (50.1%) and scald (44.6%) injuries were most common. Inhalation injury occurred in 25.8% and 21.3% required mechanical ventilation. The hospital mortality rate was 15.6%, significantly associated with TBSA, age, inhalation injury and low serum total protein. Baux and revised Baux scores showed high predictive accuracy (AUC = 0.902 and 0.918). Logistic regression identified TBSA, age, inhalation injury and total protein level as independent predictors of mortality. Burn injuries in Jordan disproportionately affect children and are associated with substantial mortality. Early identification of high-risk patients using validated scores and prompt nutritional and respiratory interventions are essential. Multicentre studies and a national burn registry are recommended to guide future policy and care improvements.

EXPRESSION OF CONCERN: A. K. Mousa, A. A. Elshenawy, S. M. Maklad, S. M. M. Bebars, H. A. Burezq, S. E. Sayed, “Post-Burn Scar Malignancy: 5-Year Management Review and Experience,” International Wound Journal 19, no. 4 (2022): 895–909, https://doi.org/10.1111/iwj.13690.

This Expression of Concern is for the above article, published online on 14 August 2023 in Wiley Online Library (wileyonlinelibrary.com), and has been issued by agreement between the journal Editor-in-Chief, Professor Keith Harding; and John Wiley & Sons Ltd. An investigation by the publisher found that images in Figures 8B and 8C had been duplicated and rotated, albeit with different staining. In addition, the investigation found that information regarding the study's ethical approval and informed consent procedure were unclear. In addition, the study reported in the article is not registered in a clinical trial registry, as required by the journal's guidelines.

The authors responded to an inquiry by the publisher stating that the article received approval from the Aswan University ethical committee and that the study was not registered in a clinical trial registry because no trial management protocol was applied to the study. The authors did not provide original ethical approval documents as requested and did not provide an explanation for the duplicated images nor all original data for the study. The Expression of Concern has been agreed to because the concerns regarding a duplicated image and lack of clarity regarding the ethics and informed consent procedures remain unresolved. The authors were informed of this Expression of Concern.

Pressure injuries represent a significant public health challenge in the context of global population aging. As China faces rapid aging, the characteristics of its disease burden and the strategies for prevention and control remain unclear. This study analyses the trends in the disease burden of pressure injuries in China over the past 30 years, based on the Global Burden of Disease (GBD) 2021 data, and predicts the future trends over the next 20 years. The GBD 2021 data were used in combination with the Joinpoint regression model, age-period-cohort (APC) model and Bayesian age-period-cohort (BAPC) model to analyse the burden of pressure injuries in China from 1990 to 2021 and forecast trends from 2022 to 2040. Additionally, decomposition analysis was performed to quantify the contribution of population aging to the disease burden. In 2021, the number of people with pressure injuries in China was 102 938.9, the number of new cases was 397 312.3, the disability-adjustede life years (DALYs) totaled 27 383.5 and the number of deaths was 3131.5. The gender difference was characterised by ‘higher prevalence in middle-aged men, with a reversal in very old women’. Between 1990 and 2021, the burden of pressure injuries significantly increased, with population aging being the main driving factor (46.5%–65.0%). The cohort effect indicated a higher risk for those born before 1942 (RR = 1.04–1.86), and a decreasing risk for those born after 1960 (RR = 0.91). Future projections suggest a 25.8% decrease in total cases, but an increased burden in those aged 85 and older, with deaths rising by 127%. This study highlights the aging-driven burden of pressure injuries in China, along with gender differences and typical period and cohort effects. As the population ages, the burden of pressure injuries in older age groups will continue to rise. The findings provide evidence for the ‘Healthy China 2030’ initiative and call for the inclusion of pressure injury prevention and control in the core agenda of national aging governance.