International Wound Journal最新文献

The Wound-QoL assesses patients' health-related quality of life. Quick and valid interpretation of the results is crucial, but no thresholds have yet been established. Additionally, counting top box responses might be a quick approximation to the Wound-QoL score itself. The aim of this study was to develop Wound-QoL bands (i.e., thresholds) and to analyse top box responses. Patients from European countries completed the Wound-QoL and a global question. We grouped patients' Wound-QoL scores and mapped these on the global question score. Upon this, we developed sets of Wound-QoL bands and calculated the weighted kappa (κ) coefficient of agreement for each set. Moreover, we analysed the correlation of the sum of top box responses with patients' Wound-QoL. The 305 patients (mean age: 68.5 years; 52.8% male) had most frequently leg ulcers (49.2%). The final set of Wound-QoL bands with the highest κ coefficient (0.564 and 0.550) was 0–0.25, not at all/rarely impaired; > 0.25 to 1, a little; > 1 to 2, moderately; > 2 to 3, quite a lot; > 3 to 4, very much. Top box responses showed strong correlation with the Wound-QoL scores (0.961–0.961). We are confident that the Wound-QoL bands will facilitate interpretation of Wound-QoL data in routine care as well as in research.

The opioid crisis has been exacerbated by xylazine, a veterinary sedative increasingly present in illicit drugs. Xylazine causes severe skin wounds that increase the risk of morbidity. Current wound classification systems fail to address the unique features of this injury, creating a need for a tailored assessment and treatment approach. We developed the HEAL-X classification system to standardise evaluation and treatment of xylazine-associated wounds. The system grades wounds using five criteria: History, Extent, Appearance, Location, and Xylazine-specific features. Grades range from 0 (normal skin) to 5 (underlying structure involvement). HEAL-X integrates principles from existing classifications while focusing on xylazine-specific pathology. This novel system was developed by an inter-disciplinary panel and requires empirical validation through clinical application and further research. HEAL-X provides a framework for grading xylazine-associated wounds, guiding treatment from lower-grade wounds to severe cases. This system aligns with the unique characteristics of xylazine wounds, offering a more tailored approach than any existing models individually. HEAL-X addresses a critical gap in managing xylazine-associated wounds. It offers a standardised tool to evaluate wound severity, guide treatment, and improve patient outcomes. As xylazine use rises and further research refines prognostic indicators and treatment outcomes, HEAL-X provides a framework on which to build.

Skin allografts are essential in managing complex wounds, yet their availability is limited by low post-mortem donation rates. Skin harvested during body contouring surgeries offers a novel and sustainable source to expand tissue supply. We conducted a retrospective descriptive study at the Tarapacá Skin and Tissue Bank from January 2022 to December 2024. All donations from body contouring surgeries were processed as cryopreserved total skin allografts following national tissue banking standards. Variables included donor demographics, harvested area, units produced, microbiological results, and discard rates. To describe clinical performance, we present our group's initial clinical series of treated patients. From 248 living donors (mean age 41.3 years), 81 293 cm² of skin generated 2050 units. The discard rate was 27%, mainly due to a storage failure and isolated microbial contamination. Clinically, all patients achieved complete initial graft take, followed by gradual necrotic eschar formation at an average of 21 days. Eschar removal revealed vital tissue firmly adhered to the recipient bed, rich in fibroblasts and neovascular structures. Subsequent management included either escharectomy with split-thickness autografting over the neodermis, or spontaneous eschar lysis and skin regeneration, with the graft functioning as a dermal regenerator. This model increases tissue availability while providing allografts with both coverage and dermal regenerative properties.

Necrotizing fasciitis (NF) is a life-threatening infection with insidious onset but rapid progression, and diabetic patients are at high risk. This case reports a 40-year-old male with type 2 diabetes who developed severe right thigh pain with ecchymosis within 24 h after emergency appendectomy, despite an unremarkable incision appearance. Point-of-care ultrasound revealed hypoechoic cleavage (0.9 cm) with dirty shadowing, prompting immediate surgical exploration confirming NF. It only took 1.5 h from examination to surgical intervention. Ishikawa grade II NF was confirmed during the operation. After emergency debridement and targeted antibiotic therapy (meropenem + teicoplanin, course of 14 days), the patient recovered and was followed up for 2 years without recurrence. This case highlights that NF after appendectomy may be masked by incision pain, with diabetics prone to fulminant progression. Ultrasound is highly sensitive for subclinical fascial gas and should be a first-line screening tool for suspected cases.

A 40-year-old male with type 2 diabetes presented with a 48-h history of spontaneous, persistent right lower abdominal pain. Contrast-enhanced abdominal CT revealed acute suppurative appendicitis with fecalith obstruction, prompting laparoscopic appendectomy. Postoperative day 2, he developed rapidly progressive right thigh pain, accompanied by localised swelling, erythema with peau d'orange appearance (Figure 1A), and elevated skin temperature. Laboratory tests showed leukocytosis (WBC 24.77 × 10⁹/L), hyperglycemia (12.2 mmol/L), acute kidney injury (creatinine 187 μmol/L), and markedly elevated inflammatory markers (CRP 337.2 mg/L). Point-of-care ultrasound demonstrated subcutaneous fascial thickening (9 mm) with hypoechoic fissures, dirty acoustic shadowing (gas locules), and floating echogenic foci on compression (Figure 1B,C). Ultrasound-guided drainage yielded 150 mL brown, foul-smelling pus, with cultures growing Streptococcus constellatus and Enterococcus faecalis. Due to persistent severe pain (NRS 8/10), surgical exploration confirmed fascial necrosis with purulent exudate, loss of tissue resistance to blunt dissection (positive finger test), and Ishikawa Grade II involvement (Figure 1D), leading to a final diagnosis of type II necrotising fasciitis. After debridement and antibiotic treatment, the patient was cured and had no recurrence during a 2-year follow-up.

Necrotizing fasciitis (NF) is a rare but rapidly fatal soft tissue infection, with its high mortality rate (20%–40%) closely associated with diagnostic challenges [1, 2]. The nonspecific clinical manifestations, including only 50% of patients presenting with the classic triad of symptoms, coupled with significant overlap in early-stage presentations with cellulitis, result in misdiagnosis rates as high as 85%, frequently leading to delayed treatment [1]. Our case demonstrates a particularly challenging

Faecal contamination of sacral pressure ulcers occurs frequently, so, theoretically, faecal diversion using colostomies is a useful procedure. We retrospectively analysed the data of adult patients for whom colostomies were created to enhance wound healing and compared patients with sacral pressure ulcers who received colostomies and those who did not during the same period. Patients' characteristics analysed included age, gender, comorbidities, WBC count, serum CRP level and microbial profile (before creating colostomy). Additionally, we examined whether the wound was closed, the recurrence rate after wound closure, and mortality outcomes. Regression analysis indicated that colostomy creation was associated with fewer species of gut microbiota cultured and lower rates of wound dehiscence after closure; no association was found between colostomy and mortality. Colostomies help promote wound healing of sacral pressure ulcers after closure by eradicating wound infection, and do not increase patients' mortality rates.

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.

In the original publication, the following sentence was inadvertently added during revision, which was generated via a GenAI tool: “Let me know if you would like variations in tone (e.g., more technical, formal or simplified).”

The following Acknowledgements statement is now included for the article:

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.