International Wound Journal最新文献

Chronic wounds pose a public health challenge, with community pharmacists increasingly recognised for their potential role in wound care. Since all chronic wounds originate from acute wounds, pharmacists can play a proactive role in preventing chronicity. Assessing pharmacy staff's wound care knowledge is essential as initiatives to enhance their involvement are underway in Australia. This study aimed to assess wound care knowledge among pharmacists and non-pharmacist staff in Australian community pharmacies. A national cross-sectional electronic survey was conducted between January and August 2022. Developed with multidisciplinary experts, it assessed understanding of wound healing, referral protocols, wound identification, management, and dressing selection. Descriptive and content analyses were performed, and multivariate linear regression identified predictors of knowledge scores. Of 120 responses, 70% were pharmacists, 14% non-pharmacist staff, and 16% unspecified. The median knowledge score was 27 out of 37 (IQR = 21, 30; range = 5–37). Profession, experience, and prior training were significant predictors of higher scores (p < 0.001, R² = 0.347). Dressing knowledge was weakest, with only 10 out of 103 respondents (9.7%) correctly identifying all types and applications. Critical knowledge gaps underscore the need for targeted educational interventions for pharmacy staff.

Animal bites, primarily from dogs and cats, pose a significant threat, especially to children. Wound infections are common complications caused by bacterial flora in the animal's mouth, making surgical debridement and delayed primary closure the standard treatment. However, recent studies reported no increased infection rates with primary closure compared to delayed closure after adequate debridement, particularly for facial wounds. Primary closure offers better cosmetic and functional outcomes. This study presents a case series to guide decision-making on primary suturing versus leaving wounds exposed. Thirty patients with animal bites underwent surgery, including 23 dog bites and seven cat bites. Eight patients with deep facial lacerations from dog bites received immediate debridement and primary closure with epidermal and subcutaneous sutures. None developed infections, and the cosmetic results were excellent. In contrast, all seven cat bite wounds and nine infected dog bite wounds involved high-risk factors, such as puncture wounds, hand injuries or diabetes. For high-risk wounds, early debridement and leaving the wound open after initial treatment proved effective. Primary repair of facial dog bite injuries, even complex ones, is safe and yields good aesthetic outcomes. For high-risk wounds, leaving them open after debridement is recommended to minimise infection risks.

Pressure injuries (PIs) remain a problem for patient safety and the sustainability of healthcare systems. Difficulties persist in their assessment, prevention and monitoring by multidisciplinary teams. International recommendations point to this problem as a priority area for resolution in terms of patient safety. Research on the subject has been positive, resulting in several guidelines for clinical practice, but professionals' adherence remains below what is expected for their implementation. This scoping review aimed to identify interventions that increase multidisciplinary teams' adherence to the prevention and management of PIs between hospitals and the communities. The search was carried out in the MEDLINE (via PubMed), CINAHL, Scopus, Web of Science, JBI, Cochrane and grey literature databases by two independent reviewers, and led to the identification of 16 articles that met the eligibility criteria and made it possible to answer the research question. Strategies to improve adherence by health professionals include the creation and training of multidisciplinary teams, the implementation of new risk assessment models, Wound Boards, injury prevention reminders, video consultation apps, multidisciplinary rounds, documentation and recording. No studies were identified that assessed staff adherence to interventions aimed at preventing and managing PIs in the continuum between hospitals and communities, which is suggestive of the need for further research in this area.

Wound care education is underrepresented in medical students' curricula. This scoping review aims to provide an overview of the published literature on educational methods and interventions used for chronic wound care education, specifically for medical students. A five-step framework for scoping reviews was used and includes a specific research question, identification of relevant literature, selection of studies, extraction of data and synthesis of the results. In total, six electronic databases (PubMed, Cochrane Library, Embase (Ovid), Web of Science, Scopus and APA PsychInfo) were searched with pre-defined search terms. The selection and evaluation of studies were conducted in a blinded review by three independent reviewers. The review was carried out in accordance with the PRISMA-ScR checklist for scoping reviews. We identified nine suitable studies regarding educational interventions for medical students in wound care. The included papers showed a broad variety of educational approaches, such as online learning tools or hands-on skills training. The implemented interventions had a positive effect on the students' wound care knowledge and their ability to perform wound care-related clinical skills. There is no comparison of the effectiveness of the different interventions, and it is not evaluated how effective they are compared to traditional lectures. There remains a need for more wound care education with a focus on the needs of medical students.

Annually, 49 million people worldwide are impacted by lower extremity ulcers (LEUs). Diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs) are the most common LEUs. Negative pressure wound therapy (NPWT) has emerged as an effective intervention for complex wounds, offering numerous favourable wound healing outcomes. The objective of this study was to evaluate the effectiveness of single-use NPWT (sNPWT) versus traditional NPWT (tNPWT) for wound closure in LEUs. Real-world data was obtained from the US-based Net Health outpatient database between January 2014 and October 2020 and included patients with LEUs (DFU or VLU) who had been treated with sNPWT or tNPWT. The rate of wound closure and time to wound closure were selected as endpoints. The wound closure rate was significantly higher for all LEUs (p = 0.039), VLUs alone (p = 0.003) and there was no difference for DFU (p = 0.90) that were treated with sNPWT versus tNPWT. The median time to wound closure was significantly shorter for sNPWT (114 days) compared to tNPWT (140 days, p < 0.01). Using sNPWT was associated with significantly higher wound closure rates and shorter time to wound closure. The results provide supportive evidence for using sNPWT for LEUs, demonstrating the opportunity to directly decrease the clinical burden of LEUs on patients. Subgroup analysis revealed a significant difference in wound closure rates for VLU, while no significant difference was observed for DFU. The overall LEU findings may be attributed to differences in the mechanisms of action between the two devices.

The aim of this study is to determine the incidence of pressure injuries (PI) and risk factors in neonatal patients followed up in the intensive care unit undergoing surgical intervention. Neonates are recognised as a patient population at high risk of pressure injury. Although the incidence of PI in hospitalised neonates is high, epidemiological studies on postoperative PI and affecting factors in hospitalised infants are scarce. A prospective, descriptive study. This study report follows the STROBE checklist. This study was conducted with 105 patients who received postoperative care in the neonatal intensive care unit of the gynaecology and obstetrics hospital of a province in XXX between November 2023 and January 2024. The Neonatal Descriptive Characteristics Form, Neonatal Q Pressure Ulcer Risk Assessment Scale, and the NPUAP Pressure Injury Classification System were used to collect data. The mean Neonatal Q Pressure Ulcer Risk Assessment Scale risk score of patients included in the research was 18.42, and 87% of those who developed PI had a risk of skin disorders. 21.9% of the neonatal patients developed PI, and 14.3% of them had Stage II PI. The majority of PI developed in the back region, and the rate of pressure injury was higher in those who underwent cardiopulmonary surgery longer than 3 h. It was determined that the use of medical equipment such as a central venous catheter, urinary catheter, drainage tube, and vasoactive drugs affected the rate of postoperative pressure injury development in neonates. The neonatals admitted in intensive care unit undergoing surgery suffered PIs. In the case of intensive care units, the incidence is even higher. The risk increases with cardiopulmonary surgery while the presence of medical devices is the main risk factor.

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