Journal of wound care最新文献

Objective: To assess the effect of two single-use negative pressure wound therapy (sNPWT) devices on healthcare resource use (HCRU) and surgical site complications (SSCs) after orthopaedic and cardiovascular surgery.

Method: Patient data were collected from the US-based Premier PINC AI Healthcare Database between January 2017 and June 2022. Adult patients upon whom the -80mmHg or -125mmHg sNPWT device was used within predefined orthopaedic and cardiovascular surgical categories were included. The HCRU endpoints measured were index encounter length of stay (LoS), and cost at index encounter and at 30 and 90 days post-surgery. Clinical endpoints were also assessed.

Results: The mean index encounter LoS, and mean cost at index admission and at 30 and 90 days post-surgery were all significantly lower when the -80mmHg device was used, compared with the -125mmHg device, across orthopaedic and cardiovascular wounds (all p<0.0001). The odds ratio (OR) for dehiscence (30 days) was significantly lower when the -80mmHg device was used versus the -125mmHg device in orthopaedic (OR: 0.361; p≤0.05) and cardiovascular (OR: 0.422; p≤0.01) wounds. Differences between the devices were not found in superficial and deep surgical site infections or seroma for either orthopaedic or cardiovascular incisions (p>0.05).

Conclusion: The -80mmHg device was associated with significantly lower HCRU and likelihood of dehiscence after orthopaedic and cardiovascular surgery versus the -125mmHg device and there were no differences in other SSCs.

Objective: Pain in patients with leg ulcers is common and there is a need for effective treatments. The analgesic effects of botulinum neurotoxin A (BTX-A) have been well-documented and this exploratory study primarily investigated its analgesic effect in patients with leg ulcers.

Method: In this prospective, investigator-initiated, open-label, clinical trial, patients with leg and foot ulcers dominated by neuropathic wound pain were enrolled consecutively and treated with perilesional injections of BTX-A on day 0 (D0). The patients were followed-up on D21, D60 and D90.

Results: A total of 10 patients with leg and foot ulcers were enrolled in this study (≥30mm on a visual analogue scale (VAS) for pain from 0-100mm)-seven with venous leg ulcers and three with inflammatory ulcers. After starting treatment with BTX-A, pain was reduced by ≥20mm on the VAS at D21 (pre-defined endpoint) in seven (70%) patients (p<0.05). Neuropathic pain scores (Douleur Neuropathique 4 questionnaire) were significantly (p<0.05) reduced at all follow-up visits, while wellbeing scores (World Health Organization-5) increased significantly (p<0.05) after BTX-A injection. Percentage reduction of wound area was significant from D60 onwards. The wound fluid levels of interleukin-1β and the neuropeptide calcitonin gene-related peptide resembled the wound healing course. BTX-A was well-tolerated with no drug-related severe adverse events.

Conclusion: The findings of this study demonstrated that BTX-A holds potential for wound pain management and justify the need for more rigorous clinical investigations.

Objective: This study aimed to evaluate the rate at which Vulnamin (Professional Dietetics S.p.A., Italy), a combination of hyaluronic acid and amino acids, heals hard-to-heal venous leg ulcers (VLUs) by measuring percentage area reduction (PAR), wound bed condition, slough presence, infection, oedema, pain and general ulcer health. It also aimed to model the cost-effectiveness of the product as an adjunct when used alongside standard of care (SoC) of leg ulcers.

Method: Patients with hard-to-heal VLUs were treated with the evaluated adjunct product for up to six weeks. Formulations were prescribed based on ulcer size, depth and levels of slough. Treatments involved both cream and powder formulations as adjunct to SoC. Wound size was measured and photographic evidence was documented throughout. The costing analysis was based on resource utilisation and clinical effectiveness data reported from the service evaluation. The total cost of the evaluated adjunct product over a four week period was calculated to be £813.39.

Results: A total of 20 patients took part in the evaluation. Wound healing spanned 63 days, with an average size at baseline of 6.7cm². By day 7, the wound area had reduced to 5.36cm², by day 14 to 4.93cm², by day 21 to 4.42cm², and by day 35 to 3.4cm². The overall PAR reached 76.26% by day 63, showing consistent improvement. The cumulative costs associated with the evaluated adjunct product over four weeks were £2621.64, compared with the cumulative costs of SoC alone over four weeks of £1323.28. However, if the Vulnamin adjunct costs halt at four weeks, but the costs in the SoC group continue to accumulate, the cost at 111 days (16 weeks and 6 days) for a hard-to-heal wound would be £2622.93, compared to £2621.64 for the Vulnamin adjunct costs. This is the point that the healing cost of the evaluated adjunct product starts to become cost-saving to the UK's National Health Service.

Conclusion: In this study, Vulnamin showed promise in accelerating VLU healing. However, given the small sample size, and given the variability in ulcer characteristics and comorbidities, this underscores the need for further research with a larger, more diverse patient populations to confirm and extend these results. The analysis indicates positive cost-saving results based on the 20 patients within the study. Further research is needed to validate the potential of Vulnamin use in wound care.

Objective: Remote ischaemic conditioning (RIC) is known to have a positive impact on heart muscle cells, kidney and liver cells. RIC improves microcirculation in healthy skin. Microcirculation is a crucial factor in wound healing. This study examined the microcirculatory effects of RIC in hard-to-heal (chronic) wounds based on the hypothesis that RIC improves cutaneous microcirculation in hard-to-heal wounds.

Method: Patients with hard-to-heal wounds (>3 weeks) participated in the study. RIC comprised three ischaemia cycles (five-minute inflation of blood pressure cuff to 200mmHg), each followed by a 10-minute reperfusion phase on a healthy upper limb. After the third and final ischaemia cycle, a reperfusion of 20 minutes ensued. Microcirculation was continuously recorded through a combined laser Doppler and white light spectrometry.

Results: The cohort comprised 20 patients. In hard-to-heal wounds, oxygen saturation in a 6-8mm tissue depth was increased by a maximum of 11.2% (percentage change from baseline; p<0.02) and capillary blood flow was increased by a maximum of 47.7% (p<0.0001). There was no significant change of the postcapillary venous filling pressure.

Conclusion: The results of this study showed that RIC enhanced microcirculation in hard-to-heal wounds by elevating capillary blood flow and oxygen saturation.

Objective: This study aimed to investigate the wound healing properties of cold atmospheric plasma (CAP) in patients with chronic wounds.

Method: This was a prospective, multicentre, two-arm, randomised, single-blind clinical study which compared the wound healing treatment of CAP with placebo, both of which were combined with best practice wound care.

Results: The study cohort consisted of 70 patients: 35 in the CAP group and 35 in the placebo group. There was a statistically significant (p<0.0001) reduction in the wound area at the end of the study, and faster wound healing, with the use of CAP compared with a placebo device.

Conclusion: The results of this study showed that without requiring adjunctive therapies, the CAP device represents a safe, well-tolerated, and highly effective therapeutic option for wounds in that it promotes their rapid healing.

Objective: Using real-world data, a comparative effectiveness analysis of a bilayer living cellular construct (BLCC) versus a dehydrated human amnion/chorion membrane (dHACM) for use in the treatment of pressure injuries (PIs) was conducted.

Method: Real-world data (RWD) in the form of electronic medical records of patients were analysed retrospectively. Patients with no baseline wound measurements or follow-up visits were excluded. Cox and Kaplan-Meier analyses were used to compute percentages and median times to healing, respectively.

Results: A total of 1764 PIs were analysed and evaluations performed on 1046 BLCC- and 718 dHACM-treated wounds. The Cox hazard ratio (HR) demonstrated the probability of healing over 36 weeks. Patient populations were comparable. The median time to healing was 19.0 weeks for dHACM and 14.7 weeks for BLCC (i.e., 22.6% reduction in time for BLCC); p<0.0001. The frequency of healing for BLCC versus dHACM was significantly greater at week 8 (29% versus 21%, respectively); at week 12 (42% versus 32%, respectively); at week 24 (64% versus 52%, respectively), and at week 36 (73% versus 62%, respectively); p<0.0001. The HR=1.37 (95% confidence interval: 1.21, 1.56); p<0.0001. BLCC-treated PUs had a 37% greater probability of healing compared to dHACM throughout the study.

Conclusion: In this study, findings showed that BLCC improved time, percentage of healed wounds and probability of healing PIs. RWD/comparative effectiveness analysis studies are beneficial to clinicians and help guide policymakers regarding reimbursement decisions.

Objective: To verify the utility and accuracy of periwound regional oxygen saturation (rSO₂) as a wound healing predictor of toes in patients with chronic limb-threatening ischaemia (CLTI), and compare the results with skin perfusion pressure (SPP) measurements.

Method: Patients with hard-to-heal (chronic) toe wounds and CLTI, and who had undergone toe rSO₂ (near wound), forefoot rSO₂ and SPP measurements, were retrospectively selected. Following the measurements, the patients were treated conservatively, and the progress of wound healing was evaluated 28-91 days after the rSO₂/SPP measurements. Toe wounds were classified into two groups: healing and non-healing. Receiver operating characteristic curves were created for rSO₂/SPP to evaluate the accuracy of the wound healing prediction index, and the area under the curve (AUC) was also evaluated.

Results: A total of 118 toes from 76 limbs were included in the evaluation and analysis. The AUC of periwound rSO₂ was 0.938 (cut-off value: 44%; sensitivity: 0.955; specificity: 0.793). The AUC of plantar forefoot rSO₂ and SPP were 0.789 and 0.786, respectively. The dorsal forefoot rSO₂ and SPP demonstrated lower accuracy as wound healing predictors compared with the plantar side (AUC: 0.551 and 0.758, respectively).

Conclusion: In this retrospective study, periwound rSO₂ was a highly accurate predictor of toe wound healing in patients with CLTI. Both plantar forefoot rSO₂ and SPP demonstrated moderate-to-high accuracy as predictors of toe wound healing, but less than that for periwound rSO₂. Prospective studies in controlled populations are required. New devices that can measure periwound perfusion may provide more accurate wound healing predictions.

Diabetic foot ulcers (DFUs) are common complications of suboptimally controlled diabetes, characterised by non-healing, high morbidity, infection, recurrence (40-50%) and mortality. Ultrasonic debridement technology has been used for >30 years to treat cataracts safely and effectively, and animal studies have suggested that ultrasound debridement stimulates collagen turnover. This technology was applied in developing a system for soft tissue removal in tendons and elsewhere, with intended use in the elbow, knee, ankle, foot and shoulder. It was then modified for the treatment of DFUs. In this study, the rationale behind using this technology is discussed, the procedural technique is described, and photographic examples of treatment outcomes presented.

Objective: Wound infections are a prevalent healthcare concern that can result in increased mortality and morbidity. It is imperative that antimicrobial-impregnated wound dressings are safe and consistently effective in preventing or treating infections and promoting wound healing. Data to this effect must be continually gathered by manufacturers during post market surveillance (PMS). This study aimed to gather relevant data about the quality, performance and safety of an antimicrobial HydroBalance biocellulose wound dressing, Suprasorb X+PHMB (polyhexamethylene biguanide) (BWD+PHMB), Lohmann & Rauscher International GmbH & Co. KG. Germany), under routine use.

Method: In this PMS, cross-sectional, retrospective study, data were obtained via online and paper questionnaires, completed by healthcare professionals.

Results: A total of 61 healthcare professionals took part in the survey. The assessed parameters of the BWD+PHMB dressing were positively rated with regards to: intended purpose; indications; contraindications; wound types; performance; safety; and usability. Observed side-effects and additional comments were noted for potential future considerations.

Conclusion: Although prospective randomised controlled trials are beneficial and considered the scientific gold standard for real-time clinical data, surveys such as that carried out in this present study are less time-consuming, cost-effective, and provide sufficient data on the clinical use of wound dressings for PMS. The evaluated dressing in this study was reported as safe and effective. It was also confirmed that antimicrobial dressings should be used for treating infected wounds or wounds at risk of infection to support the wound healing process.

Objective: To investigate the experiences of everyday life of patients with diabetic foot ulcers (DFUs) in Sweden.

Method: Semi-structured interviews were conducted from 2021-2022 with patients with active DFUs. The results were subjected to qualitative content analysis.

Results: Participants included 15 male patients and five female patients (mean age: 68 years). Responses revealed that patients felt that they had to be constantly vigilant to reduce the risk of developing a DFU. Ignoring a subtle sign could lead to disaster, i.e., amputation of the foot. This imposed a heavy burden on the patients. They also expressed sorrow over being unable to engage in cherished habits, such as swimming or walking barefoot. Some felt that doctors lacked interest in their feet, as compared with more 'prestigious' organs, such as the heart and kidneys, and they wished that they had received more information at an early stage of the disease. Pain was a significant problem for some individuals, and they did not receive adequate pain medication.

Conclusion: Despite accessible and cost-free care of DFUs in Sweden, these wounds exert profound negative impacts on patient wellbeing, not least because patients assume responsibility for avoiding worsening of their condition. Therefore, it is important for clinicians to acknowledge the patient's resources, needs and concerns, and, together with the patient, devise care goals that are realistic and achievable for both the patient and clinicians.