Journal of wound care最新文献

Objective: Dialkylcarbamoyl chloride (DACC)-coated dressing is a hydrophobic material that absorbs exudate and binds the bacteria within it to the dressing. This property has led to the use of DACC-coated dressings for a wide range of wounds. However, the bacterial load binding capacity in this dressing used with negative pressure wound therapy (NPWT) has not been evaluated, to the best of the authors' knowledge. The aim of this study was to examine bacterial loads at the wound surface in the use of NPWT with a DACC-coated dressing as a wound contact layer.

Method: A single-centre study was performed in patients with skin ulcers who had received a split-thickness skin graft (STSG). Each skin ulcer was divided into two comparable regions, one covered with a DACC-coated dressing (Sorbact Compress; Abigo Medical AB, Sweden) (DACC group) and the other with silicone gauze (control group). NPWT was used to fix the STSG. Swab samples were collected from the wound surface and the number of bacterial colony-forming units (CFUs) was measured to assess bacterial load on the day of surgery (day 0) and upon NPWT removal on day 7 postoperatively. Skin graft survival rates were compared between the two groups.

Results: The experimental cohort comprised 15 patients, yielding 15 paired regions per group (DACC and control). On day 0, there was no difference in the number of CFUs between the control and DACC groups (p= 0.136). However, on day 7, the DACC group had a lower CFU count than the control group (p= 0.0175). The skin graft survival rate did not differ significantly between the two groups (p= 0.938).

Conclusion: In this study, use of a DACC-coated dressing reduced bacterial growth when using NPWT. This suggests that this combination treatment might contribute to the promotion of wound healing.

Objective: To assess the effect of microcurrent electrical stimulation therapy (EST) on pain from hard-to-heal wounds and quantity/type of analgesic needed in its management.

Method: Patients with painful, stalled leg ulcers were treated with microcurrent EST. Pain scores (0-10 on a numerical rating scale (NRS)) and analgesic consumption were recorded daily for a seven-day run-in period and during treatment with EST for 24 days. Patients were followed up for six months.

Results: There were 20 patients in the experimental cohort. The median wound duration was nine months (range: 1.5-60 months); wounds included venous (14/20), arterial (5/20) and mixed aetiology (1/20) ulcers. Mean wound pain reduced significantly, from a value of 5.7 at baseline to 3.7 after 24 days of treatment (n=20; p<0.0001). Median time to achieve no/mild pain (NRS 0-4) was five weeks after the start of treatment. The median number of analgesics being taken for wound pain reduced between baseline and end of treatment from 2 to 1 (range: 0-4 at both timepoints). Mean daily dose reductions were observed for gabapentin, ibuprofen and paracetamol. Among patients taking analgesics for wound pain at baseline, 3/19 were able to discontinue all analgesia. After initiation of EST, the mean wound size reduction was 41% over four weeks, (10.2% reduction per week). The median time to healing was 18 weeks.

Conclusion: In this clinical evaluation, patients treated with microcurrent EST reported reduction in pain and reduced analgesic consumption.

Objective: Wound healing fundamentally requires an intact haematologic profile, and an adequate number and function of leukocytes, erythrocytes and platelets is a precondition for quelling infection and remodelling damaged tissue. Hyperbaric oxygen therapy (HBOT) is an adjunctive management for chronic and complex wounds and, unlike many classical elements of multidisciplinary wound care, its effects are not wholly mediated by these cell lineages. HBOT is known to enhance oxygen delivery to tissues, and support microvascular growth, to facilitate wound healing. HBOT also promotes the mobilisation of endogenous stem cells; however, its use in combination with bone marrow transplantation to augment engraftment is controversial.

Method: We describe a case report in which HBOT was successfully applied as part of ongoing adjuvant treatment for a complex sacral wound, in the context of myelodysplastic syndrome and aplastic anaemia, to facilitate allogenic bone marrow transplantation and subsequent recovery.

Results: After ongoing wound deterioration despite conventional therapy and wound care, the patient underwent a total of 49 sessions of HBOT at a pressure of 2.0 atmosphere absolutes, each for 90 minutes (including two air breaks). Allogenic stem cell transplantation was performed after the ninth treatment. The patient's complex sacral wound demonstrated markedly increased granulation in the early phase of HBOT, and after concurrent bone marrow transplantation it resolved completely by secondary intention. More than one year later it remained completely healed, and repeat bone marrow biopsy demonstrated a normocellular aspirate with stable circulating cell counts.

Conclusion: Our report describes the novel advantages of HBOT over other conventional wound therapies in the context of severe haematologic compromise and supports its potential for synergy with bone marrow transplantation.

Objective: The aim of this clinical trial was to evaluate the performance and local tolerance of an innovative mesh-free contact layer (healing matrix) made of lipidocolloid technology (TLC) in the management of various wounds. This dressing is made highly flexible by the absence of textile mesh in its core.

Method: A four-week, prospective, multicentre clinical trial was conducted on the evaluated dressing (UrgoFit, Laboratoires Urgo, France) in 23 centres in France. Eligible patients were adults with a cutaneous wound of acute or chronic origin or due to epidermolysis bullosa (EB) in the granulation stage. The primary endpoint was the relative wound area reduction (RWAR) at week 4. Secondary endpoints included wound closure rate and time-to-heal, as well as dressing change frequency, pain at dressing removal, local tolerance and acceptability of the dressing.

Results: A total of 78 adult patients (23-95 years old) were treated with the dressing over a period of 24±8 days. Wound aetiologies included: postoperative or traumatic finger wounds; skin graft donor sites; dermabrasions/skin tears; burns; leg ulcers (LUs) of predominantly venous origin; a stage 3 pressure injury; and EB lesions. The median RWAR at week 4 was 98.2% (ranging between 61.5-100.0%, depending on wound types). Complete closure was achieved in 49% of patients (59% in acute wounds, 60% in EB lesions and 16% in chronic wounds) with a median time-to-heal of 16.5 days (ranging between 14.5-27.0 days, depending on wound types). Half of LUs reached a RWAR ≥40% at week 4, a predictive indicator of complete wound healing at week 24. Dressings were changed every 2±1 days on average (and left in place for a maximum of 10 days). Since the first application, the dressing was judged by healthcare professionals (HCPs) to be 'very easy' or 'easy' to apply on 96% of wounds, with a 'very good' or 'good' conformability to 94% of wound beds. Similar results were reported in cases of finger/hand wounds. Since the first week of treatment, the dressing removal was also judged 'very easy' or 'easy' in 95-98% of the cases, protecting and preserving newly formed tissue in 100% of cases. At the first follow-up visit, patients reported the dressing changes to be painless in 95% of cases. This represented a significant improvement over the previous dressings they received (p<0.0001). In all, seven non-serious adverse events related to the dressing were reported during the study period.

Conclusion: In this clinical trial, the innovative mesh-free TLC dressing was shown to promote wound healing, to be well tolerated and well accepted by patients and HCPs, in line with the evidence available on other TLC dressings; however, its enhanced conformability may provide an additional benefit for the management of wounds.

Background: The original STRIDE algorithm covered lower-limb lymphoedema but not the upper body.

Aims: To update the STRIDE algorithm for compression selection to treat lymphoedema of the upper limb, breast and trunk by achieving consensus on the definitions and importance of its six aspects.

Method: Using a modified Delphi framework, clinical experts in the field ranked agreement and gave open-ended feedback over two rounds of surveys, with a >70% threshold for agreement.

Results: In the first round, participants represented five continents (n=36). Characteristics that met the threshold consensus of >70% agreement were then applied to the STRIDE algorithm, and the second survey was developed. In the second round (n=22), the definitions of all elements of the STRIDE algorithm had at least 70% agreement or strong agreement. Shape and issues were the elements most often considered first in compression selection, while refill was least often considered first in selection.

Conclusions: This Delphi study achieved consensus on the descriptions of the elements of the revised STRIDE algorithm for compression in upper-limb, breast and trunk lymphoedema. The STRIDE algorithm can now be used to make clinical decisions on selecting compression garments for the upper body.

Background: Negative pressure wound therapy (NPWT) has revolutionised the management of complex wounds via mechanisms such as microdeformation, angiogenesis and exudate control. However, its clinical effect has historically only been evaluated by qualitative and visual parameters. This study integrates near-infrared spectroscopy (NIRS) as a biofeedback tool to quantify physiological response to NPWT in real time.

Objective: This study aimed to quantitatively demonstrate the physiological and structural changes induced by an NPWT system in patients with complex wounds, measured using NIRS.

Methods: A prospective real-world observational study was conducted with a cohort of 23 patients with 33 wounds. Structural and physiological parameters were documented before and after NPWT treatment. Random-intercept mixed-effect statistical models and pre-post comparison tests were used to assess clinical and physiological significance.

Results: The data showed a progressive reduction in wound area and volume, accompanied by an increase in tissue oxygen saturation and a sustained decrease in deoxygenated haemoglobin. These findings, objectively quantified through NIRS as a real-time biofeedback tool, highlight the improvement in oxygenation and wound-bed perfusion and support the hypothesis of tissue biomodulation induced by NPWT.

Conclusion: The integration of NIRS redefines the clinical role of NPWT, allowing therapy to be customised based on specific physiological data. This combination represents a new frontier in precision wound medicine. The results of this study provide a foundation for a new generation of clinical decisions in advanced wound management.

This article presents six case studies demonstrating use of the STRIDE algorithm for selecting compression garments for upper-body lymphoedema. STRIDE offers a structured, evidence-informed and individualised approach to assessment and selection. It incorporates patients' multifactorial and evolving needs, as well as textile properties beyond pressure dosage alone to enhance long-term management and overall quality of life.

Background: Negative pressure wound therapy (NPWT) has revolutionised the management of complex wounds via mechanisms such as microdeformation, angiogenesis and exudate control. However, its clinical effect has historically only been evaluated by qualitative and visual parameters. This study integrates near-infrared spectroscopy (NIRS) as a biofeedback tool to quantify physiological response to NPWT in real time.

Objective: This study aimed to quantitatively demonstrate the physiological and structural changes induced by an NPWT system in patients with complex wounds, measured using NIRS.

Methods: A prospective real-world observational study was conducted with a cohort of 23 patients with 33 wounds. Structural and physiological parameters were documented before and after NPWT treatment. Random-intercept mixed-effect statistical models and pre-post comparison tests were used to assess clinical and physiological significance.

Results: The data showed a progressive reduction in wound area and volume, accompanied by an increase in tissue oxygen saturation and a sustained decrease in deoxygenated haemoglobin. These findings, objectively quantified through NIRS as a real-time biofeedback tool, highlight the improvement in oxygenation and wound-bed perfusion and support the hypothesis of tissue biomodulation induced by NPWT.

Conclusion: The integration of NIRS redefines the clinical role of NPWT, allowing therapy to be customised based on specific physiological data. This combination represents a new frontier in precision wound medicine. The results of this study provide a foundation for a new generation of clinical decisions in advanced wound management.