Journal of wound care最新文献

Objective: The aim of this systematic review was to assess the healing performance of extracorporeal shock wave therapy (ESWT) on integumentary wounds and musculoskeletal tissue injury.

Method: Using PubMed and Google Scholar, a systematic search was conducted in June 2021 on randomised controlled trials (RCTs) that assessed treatment efficacy of ESWT on wounds or musculoskeletal tissue injuries. Reviewed studies were stratified by target tissue and energy density level, and assessed for risk of bias. Outcome measures reported in more than one reviewed study on the same target tissue were pooled and graded for quality of evidence.

Results: A total of 296 records were considered and 14 eligible studies reviewed. Experimental design varied across studies, with ESWT applied at energy densities ranging from 0.08-0.58mJ/mm². The performance of ESWT matched or exceeded that of placebo-controlled treatments and/or standard of care in all reviewed studies. In addition, 12 studies-including all studies on wounds-reported significantly faster tissue healing and/or greater pain reduction with ESWT compared with the comparator treatment(s). Evidence from pooled analyses favoured ESWT and ranged from very low to moderate in quality.

Conclusion: The findings of this systematic review suggested that ESWT supported wound healing and is a promising treatment method for musculoskeletal tissue injuries. An implementation of standardised, tissue-specific ESWT protocols will benefit future evidence-based investigations that compare findings between studies on the same targeted tissue. Additional results from well-designed, appropriately powered RCTs will aid decision-making and further inform the clinical evidence of the tissue healing benefits provided by ESWT.

Objective: To describe a quality improvement project based on the 'Standards for Quality Improvement Reporting Excellence' (SQUIRE) guidelines, to implement care bundles for pressure ulcer (PU) prevention and management.

Method: The study was conduct in the medical, surgical and intensive care departments of six hospitals in northern Italy, between 2002 and 2020. The data collection was carried out by the unit's nurses and nurse managers. Implementation strategies included the dissemination of the PUs standard of care, the engagement of the unit nurses' mangers, the definition and the adoption of a clinical tool for PU risk assessment, the decision algorithm for the Braden score range and the class of air surface, the definition of PUs being monitored and the auditing system.

Results: The development of a quality improvement programme allowed the authors to invest in a structured plan of organisational interventions, which impacted different areas such as leadership, staffing, information technology, performance and improvement. There was no significant change in the prevalence of PUs, which remained at around 11%, but the improvement program allowed for standardisation of PU risk assessment and the supply of air mattresses in the company. Therefore, an evidence-based PU prevention and management bundle, drafter by a multidisciplinary team, was implemented at the six hospitals.

Conclusion: Despite PU quality improvement programmes promoting healthcare professionals' adherence to evidence-based practice, demonstrating a measurable reduction in PU rates can be challenging in real-world settings. However, standardising clinical practice can generate reliable data to support targeted investments in nursing care and help establish an audit framework for evaluating clinical and organisational outcomes.

Declaration of interest: The authors have no conflict of interest to declare.

Objective: While early excision of burn wounds is known to improve outcomes, the precise optimal timing within the early period remains unclear. A previous study by the authors suggests possible superiority in outcomes associated with immediate/expedited excision. This study aims to assess whether there is a difference in outcomes if initial excision is performed immediately (<24 hours), expedited (24-72 hours), or early (3-6 days) in adults with burns-related injuries of >20% total body surface area (TBSA).

Method: The authors performed a retrospective review of adults admitted to the Johns Hopkins Burn Center (Baltimore, US). The authors stratified the study groups based on pre-established definitions of time-to-excision: immediate (<24 hours); expedited (24-72 hours); and early (3-6 days). They assessed: blood-loss during the initial surgery; transfusion requirements; pain levels; daily analgesic requirements; complications; readmissions; length of stay (LoS) and mortality.

Results: The records of 1035 adult patients were reviewed, of which 99 patients with >20% TBSA required excision. Data showed 10 patients were in the immediate group, 63 in the expedited group, and 26 in the early group. Patients in the expedited group had significantly (p<0.05) greater blood loss, transfusion requirements, pain scores, analgesic requirements, readmissions, LoS and mortality than patients in the immediate and early groups.

Conclusion: The findings of this review suggest a bimodal optimal time-to-excision of 'immediately' or 'early'. The expedited group appeared to have worse outcomes. The immediate group had favourable outcomes, possibly due to the removal of the inflammatory nidus before systemic dysfunction took place, while the early group had favourable outcomes possibly due to the resolution and stabilisation of the patients' haemodynamic and inflammatory status. Based on the authors' data, immediate (<24 hours) and early (3-6 days) excision of burns are superior to expedited excision (24-72 hours). These results strongly argue in favour of a randomised, controlled trial to help define the optimal timing of burn wound excision.

Background: Flap reconstruction for pressure ulcers remains a surgical challenge, requiring careful selection of suitable patients to optimise outcomes. Postoperative care, especially pressure offloading, is critical for the prevention of complications, which include failure of the skin flap and wound recurrence. While the rates and risks of postoperative complications have been acknowledged, the challenges of postoperative care have been largely unaddressed.

Method: A 10-year retrospective review of all patients undergoing flap reconstruction for pressure ulcers at the College of Medicine (University of Florida, Florida, US) was conducted to elucidate factors that affected delays to discharge, post-discharge disposition (where the patient is discharged to), postoperative care and associated complications.

Results: Among patients who underwent multiple separate reconstructions, disposition to home versus a skilled nursing facility (SNF) or long-term acute care hospital (LTACH) had a significant association with a higher risk of complications.

Conclusion: In these high-risk patients, a multidisciplinary approach that would ideally be put in place preoperatively should be used to optimise postoperative care and prevent unnecessary prolonged hospitalisation.

This case-series supplement serves as an educational resource for health professionals involved in the care of burn injuries. Drawing from clinical experiences across healthcare settings in the Asia-Pacific region, the supplement focuses on the use of polyhexamethylene biguanide and betaine surfactant (PHMB-B) solution, gel and high-viscosity gel, alone or in combination, in managing both thermal and non-thermal burns, including partial-thickness and full-thickness burns, in both paediatric and adult populations. In alignment with international guidance, this supplement reinforces the recommendation to integrate PHMB-B into routine practice. The broad-spectrum antimicrobial activity, low cytotoxicity and biofilm-disruptive properties of this combined solution is clinically appropriate for use in complex burn wounds, where infection control and optimal healing conditions are crucial to wound healing.

Until recently, autologous punch grafting was reported for the treatment of vitiligo and other skin diseases such as nevus depigmentosus, piebaldism and postinflammatory or chemical leukoderma, as well as for ulcers and leg lesions. However, no studies have investigated its use in managing complications arising from necrotising fasciitis, to the best of the authors' knowledge. Given the nature of this bacterial infection-which affects the full thickness of the skin in the lower limbs-the favourable results achieved with punch grafting in ulcers suggest promise for its application in necrotising fasciitis as well. The authors present the case of an older male patient with necrotising fasciitis on the left leg, treated with autologous punch grafting. His medical history included obliterative arteriopathy, type II diabetes, and orthotopic heart transplantation under immunosuppressive therapy. He was hospitalised for cellulitis with tissue necrosis. After antibiotic therapy and surgical debridement, he was treated with autologous punch grafting from April to October 2021. By the end of treatment, complete restoration of skin integrity was achieved. In conclusion, autologous punch grafting may represent a valuable alternative for treating extensive ulcerations caused by necrotising fasciitis-particularly in immunocompromised patients-given its technical simplicity and the resulting improvement in quality of life.

Objective: Antimicrobial resistance (AMR) poses a significant global health threat, particularly in wound care, where non-healing wounds often harbour pathogens that complicate healing and reduce treatment efficacy. Despite available guidance, antimicrobial use remains inconsistent and often lacks alignment with antimicrobial stewardship (AMS) principles. This study aimed to assess global practices in, and awareness of, infection prevention, management and AMS in wound care.

Method: A cross-sectional survey was distributed to a global database of more than 66,000 healthcare professionals. A total of 712 responses were collected between August and September 2025. The survey contained 27 questions, exploring infection management, the use of antiseptic cleansing solutions, topical and systemic antimicrobial use and AMS implementation from across a wide range of healthcare professions globally, with a focus on wound care.

Results: Participants represented diverse clinical roles and settings, with most identifying as specialist wound nurses. While 59.4% followed formal infection protocols, 37.2% reported not following AMS guidelines. Antimicrobial dressings such as silver, iodine, polyhexamethylene biguanide, chlorhexidine gluconate and honey were reported to be used by 88.2% of participants, with 41% reporting 'just in case' use of antimicrobial dressings. Antiseptic cleansers were also widely used. AMS leadership structures varied. Key support needs for decision-making included clinical evidence (77.9%), treatment pathways (71.6%) and guideline development (71.6%).

Conclusion: Findings highlight both strengths and gaps in infection prevention, management and AMS implementation. High use of antimicrobial dressings in general and as a precautionary measure may indicate a lack of adherence to AMS principles. The lack of consistency in AMS leadership reported within clinical settings may indicate a variation in protocols and practice across wound care. Greater integration of evidence-based guidance, education and leadership as part of wider AMS structures and teams are needed to support consistent antimicrobial use and mitigate AMR in wound care.