Journal of wound care最新文献

Objective: Prevention of neuropathy-related diabetic foot complications requires early, safe and quantifiable techniques for medical intervention. In this pilot study, the feasibility of spatial frequency domain imaging (SFDI) as a quantitative tool for plantar neuropathy risk stratification is examined.

Method: A small pilot study was conducted with participants from four categorised demographics: Control-1 (<50 years of age); Control-2 (≥50 years of age); patients with diabetes without neuropathy (59-67 years of age); and patients with diabetes with neuropathy (56-71 years of age). Each participant went through the same postural series (prone, elevated, reclined) while SFDI of the plantar region of the foot was acquired. The images were then analysed to estimate regional perfusion metrics, including regional oxygen saturation, concentration of oxy/deoxyhaemoglobin at the third metatarsal head and median values of the foot including heel.

Results: In all 20 participants, elevation of the foot resulted in reduced haemoglobin concentrations in both the papillary and reticular dermis layers. Patients with diabetic neuropathy were found to have higher total (both oxy/deoxy) haemoglobin content in all positions relative to other participant groups. Furthermore, these participants also had higher variance in their haemoglobin concentrations relative to healthy participants.

Conclusion: In this pilot study, the postural regulation of perfusion metrics appeared to be correlated with disease progression, and showed a potential application of SFDI as a noninvasive, rapid and quantitative test. Participant group data indicated further investigation into postural perfusion is recommended for earlier detection of disease and as a qualitative healing metric.

Objective: This retrospective study aimed to investigate the epidemiological characteristics and associated influencing factors among patients with hand burns at a single centre in northern China from 2010-2021.

Method: The study retrospectively included inpatients with hand burns admitted to a major burn centre in northern China from 2010-2021. Demographic, injury-related and clinical data were extracted from the hospital's electronic data collection system. Factors influencing the Barthel index at discharge and the occurrence of amputations were analysed using univariate and multivariate logistic regression analysis.

Results: The experimental cohort included 1514 inpatients. The majority of patients with hand burns (83.95%) were young or middleaged (18-59 years). The incidence of hand burns remained relatively stable throughout the years studied, with higher occurrences in spring and summer. Approximately three-fifths of the patients with hand burns (58.52%) were workers, and about one-third of these injuries (36.33%) occurred in the workplace. Flame burns were the most common cause (42.47%), followed by electrical burns (28.34%). Nearly half of the patients had a burn area of <10% of total body surface area (41.15%), while over half experienced full-thickness burns (62.62%). At discharge, about a quarter of patients (24.64%) had a Barthel index <60, which was independently influenced by age, burn area, cause of injury and amputation. Electrical burns, vascular injury and full-thickness burns were identified as independent risk factors for amputation.

Conclusion: Electrical burns leading to amputation is a significant factor affecting self-care ability after hand burns in northern China. Although the proportion of electrical burns is smaller than that of flame burns, the harm caused by electrical burns is greater. The safety of fire and electricity still needs special attention and extensive education.

Objective: Chronic ulcers are wounds that have failed to close within 30 days. Practitioners need a solid knowledge base for assessing and treating these ulcers. This scoping review aims to establish the current knowledge base, determine if any medical specialty is more affected by this issue, and if any barriers exist to prevent practitioners from developing that knowledge base.

Method: This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews and the JBI Manual for Evidence Synthesis. All peer-reviewed literature published in English from 2016-2022 was reviewed. Search terms included: wound care; chronic wound care; algorithms; wound healing; and wound management, with several Boolean operators to maximise the literature results. OneStill Search, through A.T. Still University, US, was used to search for literature, as it covers 198 databases, including PubMed/MEDLINE Plus, CINAHL Plus, and Cochrane Library. Additional literature was obtained through reviewing the reference list of selected studies.

Results: A total of 13 studies matched the criteria of this scoping review. The majority were qualitative and published in 2019, 2020 and 2021. General/primary care practitioners were the main population studied. Despite the current available education, practitioners' knowledge base in assessing and treating chronic ulcers was lacking, with arterial assessment, the use of compression prior to arterial assessment, and the overuse of antibiotics where not clinically indicated, being the three most noted issues. Readily accessible, evidenced-based information in an easy to understand form appeared to be the greatest barrier to improving practitioners' knowledge base.

Conclusion: General/primary care practitioners were shown in this review to have a lack of knowledge base in chronic wounds; however, due to the limited studies in other medical specialties, it could not be determined whether other practitioner groups had a poorer level of knowledge in this field. The review did show the extent of the problem among general/primary care practitioners. Further studies need to be developed with other specialties, especially mid-level practitioners, to solidify the extent of the problem with regards to lack of wound care knowledge. New educational approaches will be needed to address the problems with the current educational tools described in this review.

Objective: The majority of ulcers in the inpatient setting are pressure-induced or diabetic. As such, research on inpatient ulcers often focuses on these aetiologies. In this study, the authors aim to present the characteristics of patients with atypical cutaneous ulcers (such as, inflammatory, neoplastic, vascular, infectious, drug induced or multifactorial) in the inpatient setting, or non-diabetic, non-pressure ulcers, that require consultation by a specialty service.

Method: This is a retrospective review of patients at Oregon Health & Science University who underwent formal consultation for a cutaneous ulcer between October 2015 and November 2020. Patients were identified from vascular surgery, plastic surgery, infectious disease and dermatology consultation databases.

Results: Of the 322 identified patients, 120 were included in the review. The mean patient age at the time of specialty service consultation was 52.46±14.29 years; 54.2% were female (n=65), 8.3% were homeless (n=10) and the majority of patients (n=114, 95.0%) had at least one comorbidity. The most common final diagnoses of ulcer aetiology were: multifactorial (n=36; 30.0%); infectious (n=28, 23.3%); and inflammatory (n=21; 17.5%). Of the patients, 22 (18.3%) were deceased by the time of this retrospective review.

Conclusion: Patients with atypical ulcers often have comorbid conditions and increased risk of mortality, and may require complex, multispecialty care. Further prospective research evaluating factors that predispose patients to increased morbidity and mortality for these ulcers is indicated.

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.