Journal of wound care最新文献

Objective: The purpose of this research was to develop an automatic wound segmentation method for a pressure ulcer (PU) monitoring system (PrUMS) using a depth camera to provide automated, non-contact wound measurements.

Method: The automatic wound segmentation method, which combines multiple convolutional neural network classifiers, was developed to segment the wound region to improve PrUMS accuracy and to avoid the biased decision from a single classifier. Measurements from PrUMS were compared with the standardised manual measurements (ground truth) of two clinically trained wound care nurses for each wound.

Results: Compared to the average ground truth measurement (38×34×15mm), measurement errors for length, width and depth were 9.27mm, 5.89mm and 5.79mm, respectively, for the automatic segmentation method, and 4.72mm, 4.34mm, and 5.71mm, respectively, for the semi-automatic segmentation method. There were no significant differences between the segmentation methods and ground truth measurements for length and width; however, the depth measurement was significantly different (p<0.001) from the ground truth measurement.

Conclusion: The novel PrUMS device used in this study provided objective, non-contact wound measurement and was demonstrated to be usable in clinical wound care practice. Images taken with a regular camera can improve the classifier's performance. With a dataset of 70 PUs for single and multiple (four images per PU) measurements, the differences between length and width measurements of the PrUMS and the manual measurement by nurses were not statistically significant (p>0.05). A statistical difference (p=0.04) was found between depth measurements obtained manually and with PrUMS, due to limitations of the depth camera within PrUMS, causing missing depth measurements for small wounds.

Prepectoral breast reconstruction is a relatively new surgical technique that allows placement of the implant directly over the pectoralis major. It has benefits in terms of patient wellbeing, operative time, postoperative pain and recovery. However, in cases of infection, implant removal is often required and the patient is left with a flat chest. To the authors' knowledge, this is the first case of breast implant infection after breast reconstruction, successfully treated with a combination of both negative pressure wound therapy (NPWT) and photobiomodulation (PBM). A 32-year-old female patient with a BRCA2 mutation had undergone bilateral risk-reducing, nipple-sparing mastectomy for in situ ductal breast carcinoma followed by a prepectoral reconstruction. On the left side, the patient presented with dehiscence of 2.5cm with implant exposure 90 days after surgery. After an initial conservative approach, the patient's condition worsened, and she developed a larger dehiscence and a red breast. She was treated with implant removal. PBM of the cavity and the application of VeraFlo Therapy (3M, US) with a polyurethane-foam filling in the residual cavity were adopted. Pseudomonas aeruginosa was isolated and appropriate antibiotic therapy was started. Every 48-72 hours, she returned to the operating room for a washout, PBM, microbiological swabs, foam exchange and continuing NPWT. After 21 days of this approach and two consecutive negative swabs, the patient underwent breast reconstruction with a subpectoral expander. After six months, a definitive implant of the same size as the contralateral one was positioned. The cosmetic result was good and patient satisfaction was high. The combination of NPWT and PBM may represent a good solution in case of breast implant infection after prepectoral reconstruction with benefits in terms of surgical outcome, patient satisfaction and postoperative quality of life.

Objective: In full-thickness wounds, it is necessary to have an appropriate dermal replacement because dermal tissue does not regenerate into normal dermis after injury. The use of a dermal matrix underneath a skin graft during the healing process provides a scaffold that supports tissue growth, resulting in improvement of cosmesis and functional outcomes. The management of large wounds with deep skin impairment using a combination of dermal matrices has not been exhaustively studied. The objective of this study was to evaluate the results of managing lower limb trauma, with deep skin impairment, by combining the use of dermal matrices in stages.

Method: This was a retrospective study of patients with lower limb trauma managed using a combination of cadaveric skin and Integra Dermal Regeneration Template (IDRT; Integra LifeSciences Corp., US) in stages, followed by an autologous skin graft, in the Hospital Aleman, Buenos Aires, Argentina from 2014-2021. Cosmesis was evaluated with the Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS). Functional outcomes were assessed one year after surgery.

Results: In total, five patients were treated. The average affected body surface area was 11.2%. The average cadaveric skin, IDRT and skin autograft take rates were 98.4%, 98.4% and 99%, respectively. Upon follow-up, six months after surgery, the mean VSS was 3.2 and the mean POSAS was 27.8. After 12 months, the mean VSS was 2.6 and the mean POSAS was 22.6. In addition, no depression of the covered surfaces was observed. All patients recovered full articular function and movement after physical therapy.

Conclusion: All patients presented full wound coverage with satisfactory cosmesis and functional outcomes. The combination of the use of cadaveric skin and IDRT consecutively in the same wound bed provides promising results for the management of lower limb trauma wounds with deep skin impairment.

Objective: New therapeutic classes of chemotherapy, including tyrosine kinase inhibitors (TKIs), are being developed, leading to unexpected cutaneous side-effects. The aim was to analyse the development of leg ulcers (LUs) associated with chemotherapy to identify their characteristics and management.

Method: A retrospective multicentre study was conducted across nine French dermatology departments and one haematology department. We collected information on cancer history, cofactors of LUs, and management and evolution of the LUs.

Results: The study included 45 patients divided into three groups: hydroxyurea treatment; targeted therapies including TKIs; and taxane treatment. Certain factors were common for arteriovenous leg ulcers, especially advanced age, the frequency of vascular cofactors and the painful nature of the ulcer; however, significant differences were apparent. In particular, the delay between the introduction of chemotherapy and the beginning of the LU. The delay in appearance of the LU was shorter for patients in the taxanes and TKIs groups versus patients treated with hydroxyurea (hydroxyurea versus taxanes: p<0.0001; hydroxyurea versus TKIs: p=0.004). Following the appearance of the LU, treatment was normally stopped (88%), with cicatrisation (91%) occurring within a period of 4.6 months on average. These results confirm the known association of hydroxyurea and LUs; however, other chemotherapies, including targeted therapies and taxanes, appear to be involved.

Conclusion: Prescribers should be made aware of skin side-effects of chemotherapies and the risk-benefit of discontinuing chemotherapy for ulcer healing should be raised. Closer monitoring to control identified cofactors of LUs is required in patients receiving this type of chemotherapy, especially if they have LU-predisposing factors.

Patients with significant peripheral arterial disease (PAD) face many challenges with wound healing. This is primarily due to lack of adequate blood flow to a wound site to allow effective healing. Restoration of adequate blood flow may require surgical as well as medical interventions. Consequently, patients with PAD may have surgical wounds in addition to pre-existing arterial ulcers they have on presentation to a vascular service. A holistic approach to wound assessment and care planning is crucial to optimise healing. This case study outlines the importance of using advanced wound therapies in addition to evidence-based holistic wound care to achieve healing in two patients with complex PAD.

Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory skin disease, and squamous cell carcinoma (SCC) is a rare complication of longstanding HS. In this case report, we describe the clinical management of a 30-year-old male patient with HS, with an eight-year history of a recurrent abscess and a nonhealing ulcer-like wound on his right buttock. The patient was also diagnosed with SCC originating from HS. A multidisciplinary team was established, comprising an oncologist, a plastic surgeon and two enterostomal therapists, to administer various treatments including chemotherapy, wound care, and surgical removal of lesions. The wound completely healed 201 days later, without any recurrence observed during follow-up.

Objective: Diabetic foot ulcers (DFUs) are a common and severe complication of diabetes, characterised by high morbidity, recurrence and risk of amputation. Hard-to-heal (chronic) DFUs often fail to respond to standard of care (SoC), necessitating advanced interventions. Lyophilised human amnion/chorion membrane (LHACM) is a trilayer placental allograft that provides extracellular matrix support, growth factors and anti-inflammatory properties to promote wound closure. This case series evaluates the effectiveness of LHACM as an adjunct to SoC in treating hard-to-heal DFUs unresponsive to conventional treatments.

Method: Patients with Wagner Grade 2 or 3 DFUs (each of which had been hard-to-heal and unresponsive to SoC for 1-3 years) and multiple comorbidities were treated with LHACM following thorough wound debridement, customised dressings and offloading strategies. Wound closure, infection control and functional outcomes were assessed.

Results: This was a case series of three male patients, aged 65-66 years. All wounds demonstrated significant size reduction within three weeks of treatment, achieving complete closure within a mean of 47 days (range: 35-56 days). No infection recurrences or complications were observed and patients resumed daily activities. LHACM's ease of application and compatibility with SoC facilitated integration into the treatment protocol.

Conclusion: LHACM demonstrated effectiveness in accelerating wound closure in complex hard-to-heal DFUs resistant to SoC, highlighting its potential to mitigate complications, reduce healthcare costs and improve patient quality of life. Further large scale studies are warranted to confirm these findings and explore broader applications in advanced wound care.

Objective: Dermabond Prineo (Ethicon Inc., US) is a combination of a skin adhesive applied over a polyester mesh to reinforce and share tension equally over the surgical wound with the aim of reducing closure time and improving wound healing. The aims of this systematic review were to assess published data on Dermabond Prineo regarding infection rates, delayed wound healing, cosmetic appearance and application time compared to conventional wound closure techniques across multiple surgical procedures.

Method: A literature search was conducted according to PRISMA guidelines. The primary outcome was the incidence of wound infection after Dermabond Prineo compared to controls, namely traditional methods of wound closure such as staples, sutures and adhesives. Secondary outcome measures included allergic reactions and time taken for application.

Results: A literature search using PubMed, SCOPUS and Science Direct identified 52 studies, of which 19 were eligible for qualitative synthesis and 12 for meta-analysis. The studies included reflected a broad range of applications of Dermabond Prineo for wound closure in abdominoplasty, mammoplasty and arthroplasty. Overall, all studies reporting on time taken for application found that Dermabond Prineo reduced time for wound closure. Meta-analysis identified a statistically significant reduction in wound infection rates (Dermabond Prineo 1.51%, control 2.13%; OR: 0.65 (0.46, 0.91); p=0.01) and a reduction in delayed wound healing (Dermabond Prineo 0.99%, control 1.79%; OR: 0.42 (0.18, 0.98); p=0.05). All three studies reporting on outcomes of scar cosmesis or long-term maturation attested to improved cosmetic results compared with sutures. The cost-effectiveness of Dermabond Prineo with a hypothetical model was discussed in two studies which concluded that it could achieve savings of $50-76 USD per patient, while a retrospective model found no statistically significant difference in total hospital costs or operating room time.

Conclusion: In this review, Dermabond Prineo showed lower wound infection rates and a reduction in delayed wound healing. Further studies are required to assess cost-effectiveness in a real-world setting.

Objective: To assess the efficacy and safety of a carboxymethylcellulose dressing containing ionic silver, ethylenediaminetetraacetic acid and benzethonium chloride (CISEB) versus a dialkylcarbamoyl chloride-coated dressing (DACC) in hard-to-heal venous leg ulcers (VLUs).

Method: In a multinational, multicentre, randomised controlled trial, patients with hard-to-heal VLUs were randomised 1:1 to receive CISEB (n=100) or DACC (n=103) for up to four weeks. VLUs that were not healed by week 4 were managed with standard of care for up to 12 weeks or until healed (whichever was sooner). The primary endpoint was complete wound closure at week 12. Additional endpoints included time to complete wound closure and incidence of adverse events (AEs).

Results: The trial cohort included 203 patients. CISEB achieved a higher rate of complete wound closure by week 12 compared to DACC (74.8% versus 55.6%, respectively; p<0.0031), and was associated with a 35% increased likelihood of healing (risk ratio, 1.35; 95% confidence interval: 1.10-1.65). Median time to complete wound closure was shorter in the CISEB arm (56 days) compared to the DACC arm (70 days; p<0.0272). A smaller proportion of patients experienced an AE with CISEB compared to DACC (5.0% versus 17.6%, respectively).

Conclusion: Management of hard-to-heal VLUs with CISEB was associated with improved healing outcomes compared to DACC, without additional safety concerns. CISEB is a gelling fibre dressing with antimicrobial, metal-chelating and surfactant components that may promote an optimal healing environment to address the challenge of hard-to-heal wounds.