Journal of wound care最新文献

Objective: Negative pressure wound therapy (NPWT) helps to reduce tissue deficits by removing excess fluid, promoting granulation tissue formation and stabilising the wound environment. This prospective, open, non-comparative clinical study assessed these factors using a canister-based single-use NPWT (CB-suNPWT) system for the management of low-to-moderate exuding pressure injuries (PIs).

Method: This 28-day multicentre investigation assessed wound progress compared with the previous visit at which the CB-suNPWT system was applied and also from baseline to study completion. Additional endpoints included: changes in wound area and volume; tissue type; exudation (amount, nature and odour); periwound skin condition; pain levels at dressing removal; tissue ingrowth into foam; system wear time; product consumption; and therapy adherence. Adverse events (AEs) were also recorded.

Results: The study recruited 35 patients with PIs at four sites in Portugal. All were included in the full analysis group. Statistically significant wound progress was observed, with 80.6% of cases showing improvement compared with the previous visit (95% confidence interval: 72.7, 80.6; p<0.05). Improvements in wound tissue and exudate levels, type and odour were also observed, and a marked increase in granulation tissue reported, combined with reductions in wound size and volume. Tissue ingrowth into the foam was reported in only two (0.57%) dressing changes. The device was well received by both investigators and patients, easy to use and managed exudate levels effectively. A minimal number of AEs were reported.

Conclusion: In this study, the CB-suNPWT device promoted improvements in the wound bed, resulting in progression towards healing of low-to-moderate exuding PIs.

Method: A prospective observational study was conducted in a neurology ward between November 2022 and October 2023. The Braden, Waterlow and Jackson/Cubbin scales were used to assess patients independently within eight hours of admission and daily thereafter.

Results: Among the 567 patients included, 37 (6.53%) developed PIs during hospitalisation. The Braden scale demonstrated a sensitivity of 70.27%, specificity of 69.81%, and an area under the receiver operating characteristic curve (AUC) of 0.73. Sensitivity, specificity and AUC values for the Waterlow scale were 89.19%, 67.17% and 0.82, respectively, while the Jackson/Cubbin scale showed values of 81.08%, 56.23% and 0.70, respectively. In terms of discrimination, pairwise comparisons of the AUC revealed that the Waterlow scale outperformed the Braden scale (Z=2.828; p<0.01) and the Jackson/Cubbin scale (Z=4.191; p<0.01). No significant difference was found between the Braden and Jackson/Cubbin scales (Z=1.209; p>0.05). Regarding accuracy, Bayes discriminant analysis indicated that the positive predictive values for the Braden, Waterlow and Jackson/Cubbin scales were 63.5%, 68.6% and 62.4%, respectively. The accuracy of each scale was assessed using calibration methods. The Hosmer-Lemeshow test revealed that the Waterlow scale exhibited better goodness of fit (χ²=6.174; p=0.628) compared with the Braden scale (χ²=13.794; p=0.087) and the Jackson/Cubbin scale (χ²=10.982; p=0.203). The calibration curve demonstrated that the predicted values from the Waterlow scale showed the closest agreement with the observed values.

Conclusion: In this study, the predictive power of the Braden, Waterlow and Jackson/Cubbin scales was found to be moderate. The Waterlow scale was superior to the other two scales in terms of both discrimination and accuracy, offering better predictive performance for stroke patients.

Objective: To assess the outcome of endovascular revascularisation in patients with diabetes presenting with ischaemic foot ulcers.

Method: This prospective observational study was conducted at the foot clinic of a tertiary care diabetes unit from August 2019 to September 2020. The Wound, Ischemia, and foot Infection (WIfI) classification method was used for wound classification. Foot ulcers were classified as ischaemic based on wound features, pedal pulses, ankle-brachial pressure index (ABPI) and arterial doppler ultrasound. Patients with diabetes with ischaemic foot ulcers were evaluated and treated according to the standard protocols. Patients undergoing endovascular revascularisation procedures were followed for 14 months post-procedure for the outcome measurement. The primary outcome of successful endovascular intervention was wound healing, either primarily or with a minor (below the malleoli) amputation.

Results: A total of 95 patients were included (70% males) with a mean age of 61.78±11.03 years and a mean duration of diabetes of 16.99±10.4 years. Almost 85% of patients had foot infections with varying severity. Endovascular revascularisation procedure was successful in 90% of the study population and almost 75% of the patients achieved wound healing. The mean ABPI significantly improved from 0.82±0.78 to 1.00±0.46 (p=0.024). On angiography, it was observed that infrapopliteal vascular involvement, either alone or in combination with infrainguinal vessels, was observed in almost 70% of patients and the majority (85%) of them had a diffuse pattern of atherosclerosis.

Conclusion: The findings of this study demonstrated that successful endovascular revascularisation had a significant impact on wound healing and salvaging limbs in ischaemic diabetic foot ulcers.

Objective: Early postoperative wound dehiscence is the most common complication of pressure ulcers (PUs). The authors previously investigated the risk factors for this complication and reported that the main cause of early wound dehiscence was surgical site infection. This study aimed to improve the surgical method to decrease early postoperative wound dehiscence.

Method: Patients with PUs between 2005 and 2022 were retrospectively investigated. In the control group, the ulcer surface was stained with methylene blue and debrided using the conventional method (surgical debridement). For comparison purposes, three test groups were established. In group 1, the ulcer surface was covered with hydrofibre with ionic silver, and debridement was performed using the covered debridement method. In group 2, debridement was performed using the conventional method and postoperative incisional negative pressure wound therapy (iNPWT) on the skin flap. Group 3 underwent both the covered debridement method and iNPWT. Patient data on: sex; age; body mass index (BMI); history of diabetes; smoking history; PU site; detection of meticillin-resistant Staphylococcus aureus in wound bacterial culture; serum albumin level; operation time; and ulcer size, were collected. Significant differences from the control group were determined for each factor.

Results: A total of 60 patients underwent flap coverage (control group: 39 patients; group 1: six patients; group 2: eight patients; group 3: seven patients). There were no significant differences between the groups for each item except for albumin level and BMI. Rates of early wound dehiscence in the control group and groups 1, 2 and 3 were 15/39 (38.5%); 2/6 (33.3%; p=0.81); 2/8 (25%; p=0.47), and 0/7 (0.0%; p=0.049), respectively.

Conclusion: A combination of methods may effectively reduce the incidence of early wound dehiscence.

A 16-year-old male patient with hypofibrinogenaemia underwent surgical resection of a haemangioma of the hand, and at 20 days postoperative, the wound was still bleeding. The patient underwent two additional debridements to stop the bleeding and repair the wound; however, these failed. The wound was located at the confluence of the third and fourth fingers of the right hand. The haematoma was found in the wound. The soft tissue defect was serious, with exposed bone. In order to stop the bleeding, acellular dermal matrix (ADM) was grafted on to the wound to repair the soft tissue defects. At two weeks post-grafting, the ADM was observed to be vascularised, the soft tissue defect was repaired, and the wound stopped bleeding. The authors believe that use of ADM is effective for the repair of a bleeding hand wound in patients with soft tissue defects accompanied by hypofibrinogenaemia.

Objective: To assess the impact of an educational intervention on pressure injury (PI) prevention practices in critical care units in Saudi Arabia.

Method: The study was conducted across three hospitals using a pre- and post-intervention approach, complemented by qualitative evaluation. It was structured into four phases, guided by the Knowledge to Action framework. The research involved collecting data on PI prevalence, surveying nurses about their knowledge and attitudes towards prevention practices, and implementing an educational intervention. Subsequently, phase 1 findings were re-evaluated. Qualitative interviews were conducted to identify barriers and facilitators to prevention practices, and to evaluate the study's effectiveness.

Results: Data were collected pre-intervention from 87 patients and 190 nurses. The initial PI prevalence rate was 60.9%, while the initial knowledge and attitude scores of nurses were 43.22% and 74.77%, respectively. A tailored group-based educational intervention engaged 294 nurses across all research sites. Post-intervention data were gathered from 94 patients and 195 nurses. The PI prevalence rate reduced significantly to 28.7%. Nurses' knowledge scores increased to 51.22%, and attitudes improved to 79.02%. Qualitative interviews with nine nurses identified three themes related to barriers and facilitators: 'Workforce and resource issues'; 'Training and preparedness' and 'Managing complex conditions'. The project's success was attributed to three themes: 'Delivering an adaptable and personalised intervention'; 'Impact of attention to detail' and 'Significance of contributing to positive change'.

Conclusion: The findings of this research underscores the crucial role of nurses in preventing PIs in critical care units. Tailored group-based educational programmes have proved effective in reducing PI rates, bolstering nurses' knowledge and attitudes, and overcoming prevention barriers.

Objective: In this pilot study, two all-in-one multicomponent compression systems designed for use in phlebological diseases were evaluated for their sub-bandage resting and working pressure performance, static stiffness index, and wearing acceptance over the course of one week in a cohort of healthy volunteers.

Method: This was a prospective, monocentric, observational, within-person randomised controlled pilot comparison study. The investigational device (InD) and the comparator device (CoD) were randomly applied to the lower legs of the participants for continuous wear, both during the day and night, for one week. The sub-bandage resting and working pressures were measured on four visits by pneumatic pressure sensors applied underneath the bandages (day of application, day 1, day 3 and final day). The height of the bandage from the foot sole to the bandage rim was measured to determine the bandage slippage over time. Participants were asked to assess comfort during and at the end of enrolment. The investigators evaluated the padding and skin protection effect of the bandages for each participant.

Results: A total of 22 healthy volunteers took part in the study. A mean resting and working pressure within the relevant therapeutic range of 20-40mmHg was achieved with both bandage systems. At application, the mean pressures were 46mmHg with both bandages and dropped to within the therapeutic range by the next day. The mean bandage slippage with both bandages was <5cm on the third day. Both bandages were well tolerated, except for itching, which was experienced significantly more with the CoD than with the InD (mean tolerance rating of at least 'acceptable' in 83% (InD) and 67% (CoD) of participants, as measured on a four-point scale). The participants confirmed 'satisfactory' or greater wearing comfort and ankle mobility (mean rating: 89% (InD) and 93% (CoD) of participants, as measured on a six-point scale).

Conclusion: Both bandages achieved therapeutic working pressures and tolerable resting pressures. Both products were well tolerated. Confirmation in a larger cohort of patients with venous leg ulcers in a real-world setting reflecting clinical routine is recommended. The study is registered with ClinicalTrials.gov database (ID NCT06728137).