International Wound Journal最新文献

Xkin closure is a newly developed medical suture device for lacerations and surgical wounds that can reduce scarring, pain and the risk of infection compared with conventional sutures or staplers. A randomized controlled study was performed to compare the wound healing effects and complications of Xkin closure with stapler closure. Fifty patients who underwent robot-assisted radical prostatectomy for prostate cancer were randomly assigned. Only the wound above the navel, which was extended to take out the prostate was targeted. The wound was examined at 2, 6 and 12 weeks after surgery, and the modified Vancouver Scar Scale (mVSS), scar height and side effects were assessed with a 3D skin analyser. Forty-six patients (23 Xkin, 23 Stapler) were analysed. The mVSS scores, vascularity and pliability were significantly lower in the Xkin group compared with the stapler group at the 12-week follow-up. No significant differences in the maximum peak and depth of the scars were detected between the two groups using 3D photographs at 12 weeks. Xkin is an effective wound closure method for improving scar outcomes. This method is expected to be widely used for surgical wounds and lacerations caused by trauma in daily life.

Osteomyelitis (OM) in diabetic foot infection could have many presentations such as an infected ulcer spreading to the bone or superimposed to Charcot neuroarthropathy. However, the sausage toe as a diabetic OM presentation was very rarely investigated; therefore, this study aims to assess the prevalence and signs of this presentation along with treatment modalities and outcomes. This is a retrospective series of patients presenting a sausage toe on admission. Several methods were conducted to diagnose OM, and three treatment modalities were applied. Two groups were compared: acute and chronic sausage toes. Outcomes were defined as sausage toe prevalence, ulcer location, OM prevalence, and comparative treatment results. Out of 82 diabetic toe infection cases, 24 (30%) presented as ‘sausage toe’. The side of the proximal interphalangeal joint of the lateral toes was the most frequent ulcer location (50%), mostly on the dorsal aspect followed by the side aspect. There were 15 (62.5%) acute cases and 9 (37.5%) chronic cases. MRI showed signs of OM in 21 (87.5%) cases and signs of septic arthritis in 3 (12.5%) cases. At the final follow-up, a successful treatment was recorded in five (20%) cases with antibiotics alone. Out of the 19 (42%) procedures, conservative surgery was performed successfully in 8 (58%) cases while amputation was needed in 11 (45.8%) cases. There was no significant difference in amputation frequency between acute and chronic groups. This is the first study documenting the sausage toe as a prevalent presentation of diabetic toe infection. The deformity is conclusive of deep infection with a very high osteomyelitis frequency. Surgery is often required for infection control and healing, mainly for chronic cases, and treatment outcomes did not differ between acute and chronic sausage toe groups. It could be beneficial to include this entity in the diabetic wound classification systems.

We recently read with great interest by Cong et al.¹ about evaluating the efficacy of combined flap coverage, antibiotic-loaded bone cement and negative-pressure irrigation in traumatic osteomyelitis management. The article effectively highlighted a synergistic strategy that integrated skin flap coverage, antibiotic bone cement and negative-pressure irrigation for the treatment of traumatic osteomyelitis. This multifaceted approach not only tackled the bone infection but also addressed the associated soft tissue defects, providing a holistic solution to this intricate medical issue. However, there are some shortcomings from our perspective.

First, the article did not detail the outcomes of bacterial cultures and drug sensitivity tests for patients with traumatic osteomyelitis in both groups. This information was crucial for understanding the treatment strategy. The selection and application of sensitive antibiotics were pivotal in the successful management of osteomyelitis. Drawing from our clinical experience, employing bone cement impregnated with antibiotics sensitive to the causative bacteria (Gram positive or Gram negative) could enhance therapeutic efficacy. And the authors mentioned that antibiotics were mixed with bone cement at a 1:5 ratio, tailored to the patient's specific condition. Given that the dosage–response relationship varies among different antibiotics, it is essential to customize the mixing ratios of sensitive antibiotics with bone cement rather than adhering to a one-size-fits-all ratio.²

Second, the pre-treatment soft tissue defect areas were 11.5 ± 1.5 (cm²) and 11.4 ± 1.4 (cm²) in the control and observation groups, respectively. To address such extensive soft tissue defects, it was important for readers to know whether the authors utilized a pedicled or a free flap.³ However, the article lacked specifics regarding the method and type of flap harvesting, as well as the location of the donor sites. This information was crucial for understanding the repair protocol. The remaining area of the wound after one month of treatment left readers feeling puzzled. The authors reported that the soft tissue defect areas one month post-treatment were 9.3 ± 1.0 (cm²) and 7.4 ± 1.0 (cm²) in the control and observation groups, respectively. It was perplexing why there remained a significant soft tissue defect area after skin flap repair. In our surgical practice, we typically employed skin flap transfer to cover all soft tissue defects to ensure the treatment objectives were met. Additionally, the article did not enumerate the body parts affected by traumatic osteomyelitis. The location of lesions (the superior, middle or inferior segment of the limbs) could influence treatment outcomes.

Third, there were a subset of patients in both groups who did not respond effectively to the treatment, showing signs

Excessive compression after parotidectomy can lead to flap necrosis, while inadequate pressure can cause fluid accumulation. This study aimed to determine the optimal pressure and compression properties of different types of dressings. Initially, pressure measurements were taken for conventional Barton's dressing and a pre-fabricated facial garment. In the subsequent phase, patients were randomly assigned to receive one of three types of pressure dressings: conforming bandage Barton's dressing, elastic bandage Barton's dressing or pre-fabricated facial garment. The dressing types were randomly crossed over the following day. The mean pressure exerted by conventional Barton's dressing and the pre-fabricated facial garment was 15.86 and 14.81 mmHg, respectively. There was no significant difference in the proportion of optimal pressure among the three types of pressure dressing (p-values of 0.195, 0.555 and 0.089 at pre-auricular, angle of mandible and post-auricular sites, respectively). The pre-auricular area demonstrated the highest proportion of optimal pressure, while suboptimal pressure was noted at the angle of the mandible and post-auricular area. Dressing types had no effect on pressure stability (p = 0.37), and there was no significant difference in patient preference (p = 0.91). Conforming bandage Barton's dressing, elastic bandage Barton's dressing and pre-fabricated facial garment exhibit comparable compressive properties, with no significant difference in patient preference and pressure stability.

The occurrence of wound infection following a Caesarean section procedure poses a substantial clinical obstacle. Transcutaneous Electrical Nerve Stimulation (TENS) has been identified as a promising supplementary treatment option for improving the healing process and decreasing the incidence of infections. This study assessed the efficacy of TENS therapy in the postoperative care of patients who have had Caesarean section. We randomly assigned a total of 108 women who had Caesarean sections to either a TENS group (n = 54) or control (n = 54). The TENS therapy was provided twice daily for a duration of 30 min for the period of 14 days following the surgery. The main measure of interest in this study was the occurrence of wound infection during 30-day period. Additionally, secondary measures included the rate of wound healing, levels of pain experienced and level of patient satisfaction. In comparison to the control (22.2%, p < 0.05), the TENS group had notably reduced occurrence of wound infection, with the rate of 7.4%. TENS group had superior wound healing results, as measured by REEDA scale, at 7 days (2.1 ± 0.8 vs. 2.5 ± 1.0, p < 0.04), 14 days (1.2 ± 0.5 vs. 1.9 ± 0.7, p < 0.05) and 30 days (0.3 ± 0.5 vs. 0.7 ± 0.6, p < 0.05). Furthermore, TENS group had reduced pain levels on the Visual Analog Scale (VAS) at all evaluation intervals (p < 0.05). TENS group exhibited significantly higher levels of patient satisfaction, as evidenced by 64.8% of participants rating high satisfaction, in contrast to 40.7% in the control group (p < 0.05). The incidence of adverse effects was found to be minor, as indicated by a skin irritation rate of 3.7% and reported discomfort rate of 1.9% at the electrode location. TENS therapy effectively decreased the occurrence of post-Caesarean wound infections, expedited the healing process and enhanced pain control. This treatment was well-received by patients and had little negative consequences. The aforementioned results provided evidence in favour of incorporating TENS into post-Caesarean care regimens, which may have significant consequences for improving patient outcomes and maximizing healthcare resources.

Tai, Y, Liu, F, Liu, T, et al. Risk factors and healing factors for pharyngocutaneous fistula after total laryngectomy for laryngeal cancer: An epidemiological study. Int Wound J 2024; 21(4):e14706. doi:10.1111/iwj.14706.

The correct corresponding authors should be Lingcao Ma and Yanzi Zang.

We apologize for this error.

I read with interest the article “Characteristics and outcomes of diabetic foot ulcers treated with surgical debridement and standardized wound care” published in your esteemed journal.¹ The study compares surgical debridement with standardized wound care for diabetic foot ulcers (DFUs). However, certain limitations and methodological issues warrant discussion.

First, the study does not thoroughly explore the impact of other diabetes-related complications on treatment outcomes. Diabetic patients often have numerous comorbidities that should be addressed, as these would likely affect the outcomes. Second, the influence of factors such as glycaemic control, diabetes duration and concurrent medications on outcomes is not clearly addressed, yet these may significantly affect the results.² Exact procedures for debridement and wound care are not extensively described, which may hinder reproducibility. Moreover, the study only included patients with adequate vascular status (Ankle-Brachial Index > 0.9), potentially excluding a significant portion of DFU patients. Importantly, the study population was limited to a single tertiary care hospital in Iran, lacking diversity in the sample, which may affect the generalizability of the results to broader, more varied populations.³ The study's short duration and lack of long-term follow-up data are crucial limitations, as understanding DFU recurrence rates and long-term treatment effectiveness is essential. Some limitations mentioned by the authors, such as the cross-sectional study design, retrospective data collection and small sample size of 75 patients, call the study's results into question. Additionally, there was no control group to evaluate the effectiveness of the treatment against other methods or standard care. Furthermore, the study does not address the cost-effectiveness of the treatment methods, which is essential for evaluating the feasibility and sustainability of the interventions in different healthcare settings.⁴

In conclusion, while the study provides valuable insights for comparing surgical debridement with standardized wound care for DFUs and highlights the need for comprehensive prevention and control strategies, addressing these methodological limitations would strengthen the article and provide a more robust foundation for future research and clinical practice. I hope the authors and the journal will consider these points in their ongoing efforts to address this important public health issue.

The authors declare no conflicts of interest.

Selective IgM deficiency is a rare immunological disorder, with patients presenting with recurrent infections and allergic manifestations. However, the association with early postoperative infection has not been widely reported in the literature. We describe a rare case of a patient who had an early wound infection 1 day after excision of a Merkel cell carcinoma from his right buttock and was later found to have decreased IgM levels. Selective IgM deficiency should therefore be considered in patients presenting with recurrent infections or in patients who have previously undergone surgery and subsequently developed early infection postoperatively. In this subset of patients, extra precautions may need to be taken pre- and postoperatively to reduce the risk of developing a postoperative infection.

Incontinence-associated dermatitis (IAD) is an irritant contact dermatitis from prolonged contact with urine or faeces, which can significantly impact patient comfort and quality of life. The identification of prognostic factors for the development of IAD has the potential to enhance management, support preventive measures and guide future research. The objective of this systematic review was to summarize the empirical evidence of prognostic factors for the development of IAD. This study included prospective and retrospective observational studies or clinical trials that described prognostic factors associated with IAD. There were no restrictions on setting, time, language, participants or geographical regions. Exclusion criteria included reviews, editorials, commentaries, methodological articles, letters to the editor, cross-sectional and case–control studies, and case reports. Searches were conducted from inception to April 2024 on MEDLINE, CINAHL, EMBASE and the Cochrane Library. The studies were assessed by two independent reviewers using the QUIPS and the CHARMS-PF for data extraction. A narrative synthesis approach was employed due to study heterogeneity and using the ‘vote counting based on direction’ method and the sign test. The overall certainty of evidence was assessed using adapted GRADE criteria. The review included 12 studies and identified 15 potential predictors. Moderate-quality evidence suggests that increased stool frequency, limited mobility and friction/shear problems are risk factors for IAD development. Female sex, older age, vasopressor use and loose/liquid stool are risk factors supported by low-quality evidence. Increased stool frequency, limited mobility and friction/shear problems seem to be risk factors for the development of IAD. There is insufficient evidence to support the predictive validity of female sex, older age, loose/liquid stool and vasopressor use. There is substantial methodological variability across studies, making it challenging to make comparisons. Large-scale cohort studies in different settings that incorporate our review findings should be conducted in the future.

Dermal substitutes have been introduced to improve the outcome of wound healing. Despite proven efficacy in trials, these skin constructs do not have a firm footing in treatment protocols. This survey aimed to gain insight into the international perspective on dermal substitutes. An open, voluntary and anonymous internet-based international survey was conducted. Eligible to complete the survey were professionals involved in the surgical treatment of patients with wounds. Information was collected on participant demographics, appointed facilitators, barriers, indications and contraindications related to the use of dermal substitutes, as well as participants' perceptions on the current available evidence and treatment protocols. A total of 148 professionals from 30 countries completed the survey. The majority of participants were male (57%), with 60% being plastic surgeons. Eighty-three percent of the professionals had experience in using dermal substitutes. The primary facilitators were ‘increased scar elasticity’ and ‘reduction of contractures’, while primary barriers included ‘costs’ and ‘contamination risk’. Sixty-two percent of the professionals acknowledged the efficacy of dermal substitutes; however, the majority emphasised the absence of clear indications and treatment protocols. This study emphasises the acknowledged efficacy of dermal substitutes while highlighting the need for clearer indications and treatment protocols.