Journal of wound care最新文献

Objective: Identification of early-stage pressure injuries (PIs) during visual skin assessment may be subjective and unreliable. An alternate light source (ALS) has been shown to increase the probability of detecting evidence of bruises on individuals with darker skin tones. Bruises and early-stage PIs are often difficult to identify, especially in those with darker skin tones, where melanin concentration is high. Given the effect skin pigmentation has on detecting both types of cutaneous injuries, this proof-of-concept study aimed to describe the characteristics of Stage 1 PIs and deep tissue PIs as viewed under an ALS.

Method: Eligible participants were first examined by a certified wound ostomy continence nurse using environmentally available white light. A blinded second examiner then evaluated the size of the potential tissue impairment using violet (406nm) and blue (448nm) ALS viewed through yellow and orange goggles, respectively. Portable ultrasound was used to confirm tissue involvement. Data were summarised using descriptive statistics.

Results: The study included 10 participants (40% of whom were from minority racial/ethnic groups) with a mean Braden Scale score of 11.1. The majority of PIs (80%) involved deep tissue and were located on lower extremities (60%). The median PI size was larger by 17.5cm² and 13.7cm², respectively, using ALS compared with white light when viewed under violet and blue wavelengths. Ultrasound data were limited to non-extremity regions (n=3 participants) with hypoechoic areas noted as being 10-13mm in thickness and up to 16.7mm deep.

Conclusion: Evidence of tissue damage that extended beyond that visualised under white light was noted with ALS. Usefulness of ultrasound was limited over bony prominences where there was too little subcutaneous tissue. Further research is warranted to investigate the potential application of ALS for the early detection of PIs.

Objective: Opioid tolerance is a criterion for opioid use disorder, which is currently an epidemic in the US. Individuals with open wounds are frequently administered opioids; however, the phenomenon of opioid tolerance has not been examined in the context of wounds. The purpose of this exploratory study was to compare patient/wound factors, wound microbiome and inflammatory mediators between individuals who were opioid-tolerant versus those who were not opioid-tolerant.

Method: Patients with acute open wounds were enrolled in this cross-sectional study. All study data were collected before and during a one-time study dressing change.

Results: The study included a total of 385 participants. Opioid-tolerant participants were significantly younger (p<0.0001); had higher levels of depression (p=0.0055) and anxiety (p=0.0118); had higher pain catastrophising scores (p=0.0035); reported higher resting wound pain (p<0.0001); had a higher number of wounds of <30 days' duration (p=0.0486); and had wounds with lower bacterial richness (p=0.0152) than participants who were not opioid-tolerant. A backward elimination logistic regression model showed that four predictors-resting wound pain, age, bacterial richness and depression-were the most important variables in predicting opioid-tolerance status.

Conclusion: These findings provide the first insights into the phenomenon of opioid tolerance in the context of open wounds. This study provides findings from which to guide hypothesis-driven research in the future.

Meleney's gangrene, also known as progressive bacterial synergistic gangrene, is a type of necrotising fasciitis. It is believed that it arises from synergistic effects of multiple bacterial agents, hence its name. In this case report, we present a non-surgical treatment approach of lower extremity Meleney's gangrene. A 32-year-old female patient was found to have a necrotic wound measuring 10×2cm on the inferior-lateral aspect of the thigh. A pouch of approximately 30×30cm was found on the subcutaneous deep muscle layer, extending to both anterior and posterior thigh. Effective treatment modalities can be implemented only if early diagnosis of this unique type of gangrene is possible. Therefore, Meleney's gangrene should be kept in mind in the differential diagnosis of subcutaneous soft tissue infections.

Objective: The prevention and treatment of burn wounds has improved over the years, leading to decreased incidence, severity and mortality. However, burn injuries, particularly partial-thickness burns, have a painful treatment course which, if not optimised, can cause undue suffering to patients and prolonged recovery. Although silver sulfadiazine has been the most commonly accepted treatment for partial-thickness burns due to its strong hindrance of infection, wide availability and low cost, it requires daily dressing changes which are labour intensive and painful. Exploring alternative techniques, such as using cultured keratinocytes, to prevent and treat burn wounds may provide a path to better optimising the path to recovery.

Method: This paper presents two cases that use two alternative treatments, either PluroGel (a gel surfactant, Medline Industries, US) or cultured keratinocytes, in the treatment of partial-thickness burns to minimise pain and enhance treatment experience.

Results: Using surfactant-based treatments, such as the gel surfactant, in partial-thickness burns exhibited prohealing outcomes via enhanced antimicrobial effects, a strengthened physical barrier and cell salvage.

Conclusion: Using cultured keratinocytes and a highly concentrated surfactant may achieve more rapid re-epithelialisation of partial-thickness burn wounds. These alternative techniques may offer significant advancement in the quality of care in burn injury treatment.

Wound healing is a complex process accompanying numerous health conditions, and millions of people across the world experience deleterious impacts caused by wounds. There are many non-biological factors that can directly or indirectly affect the health outcomes of patients with wounds. The purpose of this review was to investigate the effects of psychological, behavioural and other relevant factors on wound healing. In addition, as the possible associations among these factors have, in the authors' view, not been addressed appropriately, we also aimed to examine if there were specific relationships among these factors and between these factors and health outcomes. Finally, we reviewed the role of various interventions in buffering negative impacts during health procedures.

Little has been written about the challenges in wound healing presented by rare cases of dermatomyositis (DM) complicated by glucocorticoid use. The authors explore the clinical presentation of a 60-year-old female patient with end-stage DM, chronic steroid use and delayed wound healing, requiring surgical debridement of wounds and extensive calcification removal. Her atypical presentation-lacking some of the characteristic dermal and antibody findings-is described, while also highlighting calcification and wound trials that complicated management. The underlying pathophysiology of effects on capillary networks is discussed, as well as the effectiveness of various treatment modalities, including steroids, antimetabolites and biologics, some of which were used. The report concludes with opportunities for future study on the disease's complex mechanisms.

Objective: This study aimed to evaluate the performance of an innovative multicomponent compression system in a single bandage (UrgoK1, Laboratoires Urgo, France) in the treatment of patients with venous leg ulcers (VLUs) and/or lower limb oedema in everyday practice.

Method: A prospective, observational, clinical study with the evaluated compression system was conducted in 39 centres in Germany between March 2022 and July 2023. Main outcomes included a description of the treated patients, changes in wound healing and oedema progression, local tolerance and acceptability of the compression system.

Results: In total, 343 patients were treated with the evaluated compression system for a mean period of 48±30 days; 196 had a VLU and 275 had oedema, mostly of venous origin. By the final visit, 49% of VLUs healed (75% in absence of oedema and 61% in VLUs of ≤1 month's duration). Oedema was completely resolved or greatly improved in 87% of patients, with significant reduction in calf and ankle circumferences. Improvement in pruritus, pain, age-related ankle mobility and skin changes were also reported in patients who experienced them at baseline. The system was judged 'very easy' to apply (median: 108 seconds, three times a week), 'extremely useful' and 'very well accepted' by most patients who reported an improvement in comfort compared with previous systems. Similar results were observed when patients and/or their relatives were involved in the bandage application between the study visits. During the study, three cases of local intolerance related to the system and five early terminations (unrelated to the system) were reported.

Conclusion: These results are consistent with the previous clinical evidence available on this new compression system and further support its good efficacy, tolerability, acceptability and usefulness in the treatment of patients with VLUs and/or oedema.

Objective: The presence of microorganisms in a wound may lead to the development of pathologically extensive inflammation, and either delay or prevent the healing of hard-to-heal (chronic) wounds. The aim of this case series is to explore the use of topical gentamicin ointment, an aminoglycoside with activity against aerobic Gram-negative bacteria, as an option to address hard-to-heal wounds.

Method: We present a retrospective case series of patients with hard-to-heal wounds of varying pathophysiologies treated with topical gentamicin.

Results: Regardless of the inciting aetiology, all 10 of the presented patients responded to topical gentamicin as evidenced by resolution of much of the inflammation and reduction in wound size or complete wound closure.

Conclusion: By helping to clear the bacteria-induced biofilm that may be present on a hard-to-heal wound, gentamicin may allow the wound healing process to continue past the inflammatory phase, and onto proliferation, remodelling and eventual closure.

Objective: The Veterans Health Administration (VHA) recently piloted the implementation of the TeleWound Practice Program (TWP), which provides interprofessional wound care to Veterans remotely. We assessed the perceptions of Veterans and healthcare team members (HCTMs), and their experiences with the TWP.

Method: We surveyed Veterans from four VHA medical centres who had received at least one TWP visit between 1 May 2020 and 31 May 2021, and HCTMs associated with any TWP encounter between 1 September 2019 and 31 March 2021. Survey data were summarised using descriptive statistics and open-ended question responses were analysed using thematic coding.

Results: Out of 534 Veterans approached, 194 completed the survey (a 36% response rate). Most were interested in continuing to use TeleWound care (66%), felt more motivated to participate in their wound care due to the TWP (70%), and reported reductions in travel distance (81%) and cost (81%) related to wound care. Of the 32 HCTMs approached, 19 completed the TWP survey (a 59% response rate). Respondents indicated that the TWP improved their own professional decision-making skills (82%) and supported Veterans to take a more active role in their health (100%). Challenges included insufficient training for HTCMs, lack of stakeholder buy-in, and logistical and technical issues. Suggestions for improvement related to equipment, additional training and dedicated TWP staff.

Conclusion: In this study, the Veterans were satisfied with the TWP and were more motivated to engage in wound self-management after receiving care through the TWP. HCTMs also perceived the TWP as beneficial to Veterans. However, additional efforts are needed to address barriers to TWP implementation across the VHA system of care.