Journal of wound care最新文献

Objective: The purpose of this retrospective case series is to describe real-world clinical experience with DermaBind TL or FM, (HealthTech Wound Care, US), a dehydrated full-thickness placental membrane intended for homologous use as a protective wound covering in wounds of various aetiologies that failed to heal with standard of care (SoC).

Method: This retrospective observational, uncontrolled case series collected data from healthcare providers in the US. Eligible cases were patients, ≥18 years of age, with hard-to-heal wounds who received DermaBind TL or FM after having completed a minimum of four weeks of SoC without evidence of wound improvement. Data collected included patient demographics, wound characteristics and wound size.

Results: The cases of 27 patients encompassing 36 wounds were included. The average age of patients included was 72.4 years (range: 37-101 years). The majority of wounds were pressure ulcers (63.9%), followed by diabetic foot ulcers (19.4%) and venous leg ulcers (8.3%). Wound onset was, on average, 29 weeks prior to the first graft application with the placental membrane, and the average wound size was 34cm². Graft applications occurred weekly, with an average duration of treatment of 6.7 weeks. The observed average percentage surface area reduction across the 36 wounds was 69.1% (range: -17.6-100%). No adverse events were reported by the provider across all patient cases.

Conclusion: These observations describe the clinical use of DermaBind as a wound covering material consistent with its homologous natural protective role. Larger, prospective studies are warranted to further investigate its clinical use. The authors would like to stress that this non-randomised, retrospective uncontrolled case series was used to describe findings, such as number of grafts applied, observed percentage of surface area reduction and graft wasted, and not to demonstrate efficacy.

Objective: Lower extremity amputations (LEA) due to severe trauma, diabetes and peripheral artery disease significantly affect patients' quality of life and require comprehensive rehabilitation. Identifying predictors of LEA is crucial for reducing mortality and morbidity.

Method: This retrospective study analysed data from the Bahrain Defense Force Hospital (Kingdom of Bahrain) (2010-2020) on patients who underwent non-traumatic amputations. Statistical analyses were conducted using Statistical Package for the Social Sciences (SPSS, IBM, US), with a Chi-squared test for categorical variables and logistic regression analysis to identify significant predictors.

Results: Among the 426 patients who underwent 800 amputations, 52.8% (n=225) had minor amputations and 47.2% (n=201) had major amputations. Risk factors for major amputation included age (>70 years), sex (female), hypertension, cardiac disease and chronic kidney disease. Major amputations were significantly associated with high mortality rates.

Conclusion: This study describes the characteristics of patients undergoing non-traumatic LEA in the Kingdom of Bahrain and highlights the risk factors for these procedures, emphasising the need for targeted preventive measures and comprehensive management strategies to improve outcomes. Future studies should focus on developing interventions to address these risk factors.

Objective: To describe real-world outcomes and safety associated with Relese (StimLabs, US), a fenestrated dehydrated complete human placental membrane (dCHPM), as an adjunct to standard of care (SoC) for hard-to-heal (chronic) ulcers.

Method: A retrospective observational audit of adults with ulcers of ≥4 weeks' duration, despite SoC, treated with the dCHPM at three US centres from May 2023 to April 2025. Outcomes were summarised descriptively and included: complete closure rate; time to closure; closure category; percentage area reduction (PAR); and number of applications to closure. Safety outcomes included wound-related adverse events (AEs), amputation and mortality.

Results: A total of 23 patients with 26 ulcers (42% diabetic foot ulcers; 46% neuropathic; 12% other) were included. In the intent-to-treat (ITT) population, 54% of ulcers achieved complete closure; in the per-protocol (PP) population, 78% closed. Median time to closure was 49 days, with a median of 5.5 applications. At week 12, mean PAR was 56% in the ITT population (77% ≥50% PAR) and 86% in the PP population (100% ≥50% PAR). AEs occurred in 30% of patients, most commonly, local infection (26%) and inflammation (13%). In addition, one amputation and two hospitalisations occurred, none of which were considered related to use of the dCHPM. No serious AEs related to the dCHPM were reported.

Conclusion: In this audit, the dCHPM was associated with timely closure and favourable safety outcomes in real-world practice. These descriptive findings may contribute to the growing body of real-world evidence supporting full-thickness placental membranes as adjuncts to SoC in the treatment of hard-to-heal ulcers.

Objective: To review data from the Centers for Medicare and Medicaid Services (CMS) database in order to compare clinical outcomes of patients who were treated with Artacent Wound and Artacent AC (Tides Medical, US), a dual-layer amniotic membrane (DLAM), with patients who received debridement alone.

Method: A retrospective cohort study was conducted using a 1:1 matching procedure based on six pre-specified baseline covariates of Medicare patients who received DLAM or debridement alone for the treatment of lower extremity diabetic ulcers (LEDUs) between 2020 and 2023. LEDU episodes were constructed from claims data by linking sequential services until a 60-day clean period without LEDU-related claims was observed, which signified the end of an episode. Outcomes assessed within each completed episode included major and minor amputations, as well as emergency department (ED) visits, hospital readmissions, or care transitions to other sites of service, such as skilled nursing facilities.

Results: There were >2 million eligible episodes identified in the CMS database, of which 1244 LEDU episodes (622 in each cohort) met study eligibility and were analysed. Based on the analysis, approximately one major amputation was prevented for every 32 patients treated with DLAM as compared to debridement alone. Inpatient admissions, ED visits and skilled nursing facility visits were significantly reduced in the DLAM cohort.

Conclusion: Medicare patients treated with DLAM experienced significantly lower rates of major amputations and reduced healthcare use compared with those treated with debridement alone. Promising results from this study may provide another advanced wound care option to add to the treatment armamentarium.

Objective: Hard-to-heal wound biofilms are increasingly recognised as a major barrier to healing, contributing to persistent inflammation, delayed re-epithelialisation, and reduced responsiveness to standard therapies. While traditional sharp debridement (TSD) is a standard treatment, its limitations include the need for specialised training, the potential for pain and bleeding, and degree-specific scope of practice restrictions. This study investigated a novel multifaceted, sharp debridement device as a potential addition to the current portfolio of debridement technologies.

Method: This prospective study enrolled patients with hard-to-heal wounds, randomised equally to either multifaceted, sharp debridement (EZ-Debride, MDM Wound Ventures, US (EZD)) or TSD (scalpels/curettes). Biofilm presence and extent were assessed pre- and post-debridement using a modified Alcian blue wound blotting technique, graded on a 0-3 scale. Biofluorescent imaging (BFI) and provider clinical assessments allowed additional evaluation of the biofilm removal efficacy.

Results: The experimental cohort comprised 80 patients. Both EZD and TSD significantly reduced biofilm, as evidenced by decreased Alcian blue staining grades post-debridement (p<0.005 for both). However, EZD resulted in a significantly greater reduction in biofilm than TSD (85.0% versus 34.9%, respectively; p<0.0001). While BFI showed limited correlation with Alcian blue staining overall, in cases with positive pre-debridement BFI imaging results, EZD achieved a 100% reduction in bacterial fluorescence compared with 50% using traditional methods. Clinical assessment confirmed a higher rate of complete biofilm removal in the EZD group compared with the TSD group (60.0% versus 12.2%, respectively).

Conclusion: This study demonstrated that the novel multifaceted, sharp debridement device, EZD, is a safe and effective tool for biofilm removal in hard-to-heal wounds, potentially surpassing TSD methods. EZD offers a less invasive, more efficient, and potentially less painful approach, suggesting its value in improving clinical wound management and patient outcomes. Further research should examine its impact on long-term healing and broader clinical applicability.

Compression therapy is pivotal to the management of lymphoedema of the upper limb, breast and trunk. Compression can be achieved with a range of garment types and accessories. Distinguishing between these categories is foundational to using the STRIDE algorithm for compression selection, a tool designed to guide healthcare providers in optimising compression therapy for improved patient outcomes. This article outlines the seven garment categories of circular-knit garments, stiffer circular-knit garments, flat-knit garments, adjustable wraps, decongestive wraps, night-time garments and trunk garments, as well as two compression accessories: focal pads and donning/doffing aides. It also discusses how garments within these categories can be distinguished by textile properties, such as pressure, stiffness and containment.

This article reviews the lymphatic system's anatomy and physiology, as well as the etiology of lymphoedema affecting the upper limbs, breast and trunk. It presents evidence-based strategies for assessment, including history-taking, physical exams and clinical tests to guide treatment planning. The importance of selecting personalised compression garments is emphasised. Legislative impacts-such as the US 2024 Lymphedema Treatment Act-and global variability in compression therapy funding are explored, along with nuanced approaches to assessment, staging and diagnostic criteria.