Journal of wound care最新文献

Background: This study used a systematic analysis to identify risk factors that may be used to predict which patients with diabetes will develop a foot ulcer.

Methods: A systematic review of the literature was conducted, which included observational cohort studies that followed patients with diabetes to see whether they developed a diabetic foot ulcer (DFU). A random-effect meta-analysis was performed, and odds ratios were used for nominal data or mean differences for continuous data. This study was registered at PROSPERO (CRD42020182527).

Results: The analysis included eight studies. From 4914 patients, 607 developed a DFU (12%) within a median of 30 months follow-up, indicating a 4.8% annual rate. The following parameters were found to be related to DFU development: a history of DFUs; cerebrovascular accident; peripheral arterial disease and lower extremity amputation; duration of diabetes; glycated haemoglobin; use of insulin; visual impairment; claudication; altered monofilament sensitivity; foot deformity; onychomycosis; foot oedema; and local hyperkeratosis. The quality of evidence for most of the factors was either low or very low.

Conclusion: The development of DFUs may be associated with various factors, including: a history of previous DFUs; amputation or clinical atherosclerosis syndrome, such as peripheral arterial and cerebrovascular disease; the severity of diabetes; and various clinical signs regarding the patient's foot. The low certainty of evidence for most of these factors indicates that there is still a gap in knowledge regarding the early detection of foot ulcers in people with diabetes. A large prospective study could identify more precisely which factors are the most significant. Contemporary technology could use such data to create devices that would be able to predict DFUs so they can be prevented or treated earlier, which would reduce the possibility of lower limb amputation.

Objective: Hard-to-heal (chronic) leg ulcers (LUs) can impair quality of life and, in severe cases, may require amputation. Although there are a few studies on the use of class III laser therapy with LUs, studies using powerful class IV lasers are scarce. The present study uses a class IV therapeutic laser (K-Cube 4; K-Laser; K-Laser USA, LLC, US) which uses four wavelengths (660nm, 800nm, 905nm and 970nm) of diodes in one device to target haemoglobin, water and cytochrome c oxidase simultaneously, with different frequency modulation and high power levels to enhance clinical efficacy and produce short treatment protocols. Patients experience no pain or tissue damage with this procedure, which is non-invasive. The objective was to determine at what rate class IV laser therapy reduces the size of hard-to-heal lower LUs of different aetiologies.

Method: This study involved patients with hard-to-heal cutaneous LUs, infected and non-infected, who were non-responsive to standard ulcer treatment for at least six weeks. Medications and dressing materials remained as consistent as possible. Various comorbidities were well controlled for at least four weeks before the trial started. The maximum duration of treatment was 12 therapies, with a four-week post-therapy follow-up. Patients received laser therapy once or twice weekly, to fit in with their dressing change schedule. Ulcer size, wound bed, surrounding tissue condition, pain intensity and overall patient condition were observed. The mean daily percentage area reduction (PAR) with standard deviation was calculated after completing the entire process.

Results: The initial cohort was 20 patients. For the 13 patients who received twice-weekly treatment, the wounds increased in size by an average of 0.5559% per day in the four weeks before starting the class IV laser treatment. After starting laser therapy, the ulcer size decreased with a mean daily PAR of 1.118±1.0078%. For the six patients who received once-weekly treatment, the PAR was 0.329% per day in the four weeks before starting the laser treatment, which increased to a mean daily PAR of 0.604±1.348%. After completing three sessions, one patient declined to participate in therapy. Overall, 17/19 (89.47%) patients received a satisfactory reduction.

Conclusion: In this study, class IV laser therapy demonstrated promising outcomes in the treatment of LUs by improving wound healing. However, more large-scale, randomised controlled trials are required to create standardised techniques and fully comprehend the long-term benefits and disadvantages. The cost analysis indicated positive cost-saving results based on the patients within the study. However, these cost-effectiveness estimates are based on very small numbers and so further research is needed with a larger sample.

Objective: Radiation exposure in patients has become increasingly common in diagnostic and therapeutic procedures guided by fluoroscopy. Radiation ulcers are one of the most serious consequences of radiation therapy, especially when the cumulative radiation dose is very high. Under such circumstances, patients may experience severe pain and permanent disfigurement due to tissue destruction. This article addresses the challenges faced by the authors in managing and treating fluoroscopy-associated radiodermatitis wounds.

Method: This was a prospective case series involving patients with radiation ulcers (grade 4 radiodermatitis) induced by fluoroscopy. The treatment involved debridement of devitalised tissue, wound bed preparation and reconstruction using local or regional flaps. The assessment of wound pain was performed before surgical treatment and six months after, using a Visual Analogue Scale.

Results: The ages of the three patients included in this case series ranged from 42-71 years. Wound reconstruction was carried out with bilobed flap, V-Y advancement flap, and latissimus dorsi flap. The mean follow-up was 10 months (range: 6-12 months); during this period all patients presented with a significant improvement in pain. There was no recurrence of any wound during the follow-up period. Conclusion: Management of radiodermatitis induced by fluoroscopy is challenging and plastic surgeons play an important role in the treatment of radiation ulcers. Surgical treatment of these wounds should include debridement and resectioning of the entire lesion, followed by reconstruction with flaps. As pain related to the ulcer may be improved or relieved after surgery, surgical treatment should be considered in these situations.

Objective: Effective pressure management and comfort during prone positioning are core to improved ergonomics and patient tolerance, minimising the need for enhanced respiratory support techniques, such as mechanical ventilation. This study explored the impact of a new (low-tech) pillow solution on interface pressure and comfort during prone positioning compared with standard hospital solutions.

Method: In this healthy patient cohort, within-subject, comparative study, person-surface interface pressures were measured for three different conscious prone positioning conditions: a standard hospital pillow at the head (HPO); a three-pillow standard hospital proning solution (HPP); and a new two-pillow prone positioning solution with additional standard head pillow (LPP). Contact surface area, peak and mean pressure, peak pressure index (PPI) (head, trunk, pelvis, legs), and subjective comfort were calculated for all conditions over a 21-minute period.

Results: The study cohort comprised 20 healthy volunteers. The LPP solution lowered PPI at the trunk compared to HPP (p<0.017) and HPO (p<0.001). The LPP solution also significantly reduced head PPI compared to lying with only a head support (p<0.002). Both HPP and LPP significantly improved comfort compared to proning with a head support only (both p<0.002).

Conclusion: Overall, improved pressure management and comfort was noted for the alternative prone positioning kit, compared with existing solutions, suggesting a low-tech alternative to improving tolerance and adherence of patient prone positioning.

Objective: The South African patient population is complex, with elevated traumatic injury rates and individuals living with multiple comorbidities. Healthcare provider and funding shortages, as well as wound care training not being a recognised subspecialty, have added to the burden of an already pressured South African healthcare system. With increases in non-specialist clinicians providing wound care, South Africa-specific wound care guidelines are needed.

Method: An in-person meeting was held with wound care experts across South Africa to develop treatment recommendations for the use of negative pressure wound therapy (NPWT)-based systems. The publication panel convened on 8-9 December 2023 in Johannesburg, South Africa. The group of 14 panel members, including surgeons, wound care nurses and nurse practitioners, discussed clinical evidence regarding NPWT-based system use, followed by the development of a therapy-use algorithm.

Results: Panel members recommended NPWT use for both simple/low-risk and complex/large/high-risk wounds. NPWT with instillation and dwell time was recommended for both simple and complex wounds requiring cleansing. NPWT or closed incision negative pressure therapy use was recommended, as needed, following wound closure as per the reconstructive ladder.

Conclusion: Limited published evidence supporting the use of NPWT-based systems exists for South Africa. These panel recommendations are a starting point and should be revised as more clinical evidence on NPWT-based system use within South Africa is published.

Objective: Treating wounds with exposed tendons following trauma is challenging, as addressing such injuries typically involves providing vascularised tissue coverage. Platelet-rich fibrin (PRF) is used to generate a granular wound bed for skin grafts. This study aimed to investigate the optimal wound length for complete vascular granulation using PRF treatment.

Method: This was a retrospective case series study, conducted in the Affiliated Hospital of Nantong University, China. Between January 2016 and January 2020, patients with tendon-exposed wounds <4cm below the knee joint following acute traumatic injury were reviewed. The maximum wound diameter was measured and recorded, and the PRF clot was applied to the wound. Outcomes including the maximum wound diameter, number of patients with successful granulation and visual analogue scale (VAS) pain scores were measured. Successful healing was defined as complete wound re-epithelialisation. The receiver operating characteristic (ROC) curve was calculated to establish the threshold value for the preoperative maximum wound diameter to reliably predict complete granulation. A maximum wound diameter lower than the threshold value was considered to have a high chance of complete re-epithelialisation using the PRF treatment.

Results: A total of 62 patients were included, with a mean age of 41.2±10.7 years. All patients had a high VAS pain score of 6.1±1.0 at eight hours after surgery. There was a significant decrease in VAS scores between the first and fifth days (6.2±2.3 versus 0.2±0.4, respectively; p<0.001). The cut-off value of the wound length derived was 2.25cm and the area under the curve was 0.993 (sensitivity: 0.957, specificity: 0.933; p<0.001).

Conclusion: The findings of this study demonstrated that a wound size of ≤2.25cm had a high possibility of achieving complete vascular granulation after PRF treatment in tendon-exposed wounds. It is therefore suggested that when treating patients with a wound diameter ≤2.25cm PRF should be used.

Objective: To compare xenogeneic (porcine) versus allogeneic biological dressings after escharectomy for deep burns.

Method: This retrospective study included patients treated with escharectomy for second- or third-degree burns at First People's Hospital, Affiliated Hospital 2 of Nantong University, China, between January 2015 and October 2020. The patients were grouped according to the type of wound dressing used after escharectomy: acellular dermal porcine skin matrices (the xenogeneic group) and allogeneic acellular dermal matrices (the allogeneic group).

Results: A total of 95 patient records were analysed: 62 (45 males and 17 females) received xenogeneic dressings, and 33 (25 males and eight females) received allogeneic dressings. There were no differences between the allogeneic and xenogeneic dressings in: the survival rate of the initial skin graft (94.3% versus 93.3%, respectively; p=0.765); bio-occupation (where the biological dressing adheres and fuses with the tissue) (15.2% versus 14.5%, respectively; p=0.100); dressing dissolution (30.3% versus 37.1%, respectively; p=0.473); and infection or mildew (24.2% versus 22.6%, respectively; p=0.793). However, the xenogeneic dressings showed a longer wound healing time than the allogeneic dressings (11.4±0.4 versus 8.9±0.3 days, respectively; p<0.001).

Conclusion: Compared to allogeneic dressings, xenogeneic dressings demonstrated no significant differences, except for a longer healing time. Nevertheless, xenogeneic dressings have the potential to be a viable alternative due to their availability.

The prevention, management and monitoring of pressure injuries (PIs) have become an important quality indicator for healthcare. In an acute care organisation, hospital-acquired pressure injuries (HAPI) remained prevalent, despite the implementation of a structured plan for PI prevention. The gap in practice for January 2021 to March 2021 was a HAPI incidence rate of 6.35% in the acute care unit. The project's purpose was to implement a HAPI prevention bundle and improve nurses' knowledge of prevention measures. The measured outcome was the HAPI incidence rate on the identified unit. This quality improvement project used Lewin's change theory as the framework. The PICOT clinical question was: 'How does implementing a PI prevention bundle and validating the knowledge, skills and attitudes of nurses on a medical surgical/step-down unit result in an improvement in the HAPI rate and improve the knowledge of nurses over eight weeks compared to solely utilising the current PI hospital policy and online PI education tool?' For the eight weeks from October 2021 to November 2021, the pre-implementation HAPI incidence rate was 6.51%. Post-implementation, the HAPI incidence rate decreased by 5.5%, and knowledge scores increased by 13% (average test score pre-implementation was 75.8%). Limitations were nursing shortages due to the COVID-19 pandemic. Recommendations included implementing the intervention bundle and competency assessment in other units over an extended timeframe and with a larger sample of patients.