Journal of wound care最新文献

The execution of clinical trials in wound care significantly differs from, and is frequently more challenging than, those involving pharmaceutical agents. Populations presenting with wounds (such as trauma and ulcers) are typically heterogeneous, and often exhibit a range of comorbidities and secondary factors that influence both the nature of the lesion itself and the trajectory of wound healing. Typical comorbidities in patients with ulcers include diabetes and chronic obstructive pulmonary disease, and polypharmacy is common. Trauma-related complications, such as haemodynamic or septic shock, are frequently observed in extensive burns and other major trauma. Such complexity presents substantial obstacles to generating statistically robust and reliable outcomes, either because a consistent patient cohort is difficult to find, or extensive stratification may be necessary when different cohorts of patients with different types of lesions are put together into a single trial population. This article highlights several of the methodological and operational challenges that can arise when conducting a wound care study and tries to create some upfront awareness of the pitfalls for such studies. The author has been a chief medical officer and independent consultant to the wound care industry for >35 years, and some statements in this article are based on his personal experience and observations.

A novel macrophage-modulating cream containing proprietary extracts from Plectranthus amboinicus and Centella asiatica has been approved for the treatment of diabetic ulcers in some countries. It has been reported to suppress M1 macrophages and facilitate the transition from M1 to M2 macrophages, reducing inflammation and leading to faster wound healing. Based on its mode of action, it has also been used in non-diabetic wounds. This report describes the treatment of a patient with essential thrombocythaemia (ET) presenting initially as a toe ulcer, and which was successfully managed with the cream before the use of systemic therapy for the ET.

Objective: In French community settings, it is common to use a combination of a gelling fibre dressing (Biatain Fiber, Coloplast A/S, Denmark) and a silicone foam dressing (Biatain Silicone, Coloplast A/S, Denmark) for wound management, despite the lack of reimbursement by social security systems. A sub-analysis of the real-world, prospective, observational VIPES (Observatoire en Ville des Plaies ExSudatives) study assessed the use of this dressing combination.

Method: In this sub-analysis of the VIPES study, wound healing/wound bed outcomes and nurse/patient satisfaction were assessed.

Results: Overall, 76 patients were included. At baseline, mean±standard deviation wound area was 10.1±16.9cm², with low (35.5%), moderate (44.7%) or high (19.7%) exudate levels; 80.3% of patients had exudate pooling. At the final follow-up visit (median (range): 28.5 (2-148) days post-baseline), 27.6% of wounds had healed and 52.7% showed progression towards healing. From baseline to the final follow-up visit, there were significant reductions in wound area (by a mean of 4.7±12.3cm²; p<0.005), exudate level (p<0.0001), and exudate pooling (p<0.0001), and significant improvements in wound edges (p<0.001), and periwound skin (p<0.05). Across 403 gelling fibre dressing removals, most cases showed 'no/minor' shrinkage (94.1%) and no adherence to the wound bed (79.8%). At the final follow-up visit, wound improvement was reported by 73.0% of patients and by 77.0% of nurses. For most wounds, nurses agreed that the dressing combination reduced the number of dressing changes, led to greater synergy of action to promote wound healing versus previous dressing(s) used (79.7% and 93.2%, respectively), and achieved optimal healing (94.6% of wounds). Nurses also agreed that the gelling fibre and silicone foam dressing combination was 'very effective'/'effective' for 93.3% of all wounds.

Conclusion: In this sub-analysis, combining gelling fibre and silicone foam dressing in community practice supported healing of hard-to-heal exuding wounds.

Objective: Hard-to-heal wounds refractory to standard of care (SoC) therapy pose a major clinical and economic burden on healthcare systems. A dual-layer hydrated human amniotic membrane (HAMA) allograft, pre-hydrated with saline, is an emerging advanced therapy for complex hard-to-heal wounds. The aim of this study was to evaluate the real-world effectiveness of Membrane Wrap Hydro (BioLab Holdings, Inc., US) in achieving complete closure and relative percentage area reduction (PAR) across hard-to-heal diabetic foot ulcers (DFUs), venous leg ulcers (VLUs), pressure injuries (PIs) and open wounds.

Method: This was a retrospective multicentre analysis of patients treated from November 2024 to July 2025 after ≥30 days of optimised SoC with <50% healing. Weekly applications of HAMA were performed in outpatient clinics, nursing homes or home settings. The primary endpoint was complete wound closure (99.99-100% re-epithelialisation). Secondary endpoints were: PAR (paired samples t-test); applications to closure; and time-to-healing (Kaplan-Meier).

Results: The cohort included 80 patients (83 wounds). Complete closure occurred in 46/83 (55.4%) wounds with a median six applications (mean: 6.54±3.22). Closure rates were: 53.3% (DFUs); 50.0% (VLUs); 47.1% (PIs); and 59.6% (open wounds). Mean PAR was 84.3%, with significant area reduction from baseline (p<0.001; Cohen's d=0.79). Large effect sizes were observed across aetiologies (d=1.01-1.84). Median time-to-healing was 42 days (range: 7-110).

Conclusion: Membrane Wrap Hydro achieved clinically meaningful closure and substantial PAR across diverse refractory hard-to-heal wounds, with outcomes in PIs and open wounds comparable or superior to DFUs and VLUs. These findings support the role of HAMA as a versatile advanced therapy in multimodal hard-to-heal wound management.

Objectives: Despite the continued improvement in surgical skills and flap design, the incidence of necrosis after skin flap transplantation remains high. Hyperbaric oxygen therapy (HBOT) has been shown to be effective in improving wound healing after skin flap transplantation and this meta-analysis evaluates its role such patients.

Method: A search of research databases-PubMed; Web of Science; ClinicalTrials.gov; the Cochrane Library; China Knowledge Network; Wanfang; and Weipu-from database establishment to 26 June 2023 for randomised controlled trials (RCTs) on the effects of HBOT on wound healing in patients undergoing skin flap transplantation was conducted. RevMan 5.3 statistical software (Nordic Cochrane Centre, Denmark) was used for data analysis.

Results: A total of 13 RCTs involving 1226 patients who had undergone skin flap transplantation were included in the analysis. The studies showed that HBOT could: significantly improve the survival rate of the skin flap in patients (odds ratio (OR): 8.57; 95% confidence interval (CI): 5.54, 13.26); increase the skin blood oxygen saturation of the skin flap (mean difference (MD): 19.94; 95% CI: 18.16, 21.72) and the postoperative skin temperature of patients (MD: 0.71; 95% CI: 0.54, 0.89); reduce the time for swelling to subside (MD: -3.76; 95% CI: -4.34, -3.18), and the time taken for skin to become ruddy (MD: -4.56; 95% CI: -5.28, -3.84) (all p<0.05).

Conclusions: The findings of this meta-analysis shows that HBOT improved the survival rate of skin flaps and accelerated skin recovery in patients undergoing skin flap transplantation.

Objective: To compare the static stiffness index (SSI) between a compression garment and a ReadyWrap (Venosan, Brazil) adjustable compression garment (ACG), and analyse the clinical factors associated with increased SSI in patients with breast cancer-related lymphoedema (BCRL).

Method: In this cross-sectional study, working pressure (WP) and resting pressure (RP) were assessed using a PicoPress device (Venosan, Brazil) positioned under the biceps muscle in the arm region. The SSI was calculated as the absolute and relative difference between the RP and the highest WP recorded during muscle contraction.

Results: The study included 76 patients with a mean age of 61.7±12.6 years. During compression garment use, the mean RP was 21.9mmHg and mean WP was 40.0mmHg during biceps brachii contraction, resulting in an absolute SSI of 18.1mmHg and a relative SSI of 43.6% (p<0.001). For the ACG, the mean RP was 19.3mmHg and mean WP was 63.1mmHg, resulting in a mean SSI of 43.8mmHg and a relative SSI of 68.7% (p<0.001). The ACG produced an SSI 25.7mmHg greater than the compression garment, a 25.1% relative difference (p<0.001). The compression garment showed a higher SSI in early-stage versus advanced-stage patients (8.2%; p=0.003) and in those with conservative surgeries versus mastectomy (8.3%; p=0.005). No SSI difference was observed for the ACG when considering tumour characteristics and oncological treatment.

Conclusion: The SSI was greater with ACG use compared with the compression garment. Patients who had breast-conserving surgeries and early-stage tumours showed the highest SSI when using the compression garment. No SSI differences were found regarding patient demographic, clinical, tumour or treatment characteristics during ACG use.

This article addresses the successful wound management case of a male patient in his early 60s with a necrotising parapharyngeal abscess, by a wound care nurse in a home-based care setting with very limited resources. The case study emphasises the necessity for clearly defined legal roles for non-physician wound care clinicians in Indonesia, where resource constraints demand innovative approaches. While not advocating for a direct replacement of physicians, the case study calls for an exploration of a broader scope of practice for wound care nurse practitioners. Further research is required for the establishment of a comprehensive scope of practice for wound care nurses in Indonesia, ensuring optimal patient care while safeguarding professionals from legal complications.

Objective: Debridement is the removal of nonviable, contaminated, or foreign material from within or near a wound until healthy adjacent tissue is exposed. In sharp debridement, patients are expected to experience greater levels of pain because of cell damage. This study evaluated the effect of applying cold 0.9% sodium chloride (NaCl) during sharp debridement on pain in patients with diabetic foot.

Method: A randomised, controlled, single-blind trial was performed with inpatients randomised to two equally sized groups: an experimental group and a control group. During sharp debridement, cold (4-8°C) 0.9% NaCl was applied to the wounds in the experimental group while room temperature (18-26°C) 0.9% NaCl was used in the control group. Data were collected using a questionnaire form, a visual analogue scale (VAS) and a wound area form. The VAS was applied in both groups before and during the procedure. Descriptive statistics and Chi-squared, Mann-Whitney U, Student's t and Wilcoxon signed-rank tests were used to analyse the data.

Results: A total of 64 patients were included in the trial (32 in each group). Most of the participants in the experimental and control groups were male (84.4% and 65.6%, respectively) and the mean age was 61.8 years and 60.6 years, respectively. The participants were homogeneously distributed in terms of sociodemographic, clinical, laboratory and wound characteristics, with no statistically significant differences between the groups (p>0.05). Compared to pre-procedure values, VAS score decreased significantly during the procedure in the experimental group (p<0.001) but increased significantly in the control group (p<0.001). VAS scores in the experimental group were significantly higher before (p=0.003) and lower during (p<0.001) the procedure compared with the control group.

Conclusion: In this trial, applying cold 0.9% NaCl during sharp debridement reduced pain in patients with diabetic foot.