Journal of wound care最新文献

Compression therapy is a cornerstone in the management of upper-body lymphoedema. Compression helps reduce oedema, restore function and improve tissue integrity, contributing to enhanced quality of life and more efficient use of healthcare resources. To achieve this, compression garments must be appropriately designed, selected and applied to meet diverse patient needs. Therapeutic effect is determined by the garment's textile properties, including resting pressure, stiffness and gradient, as well as containment, fatigue and moisture wicking. This article synthesises the evidence for how these properties impact management of lymphoedema in the upper limb, breast and trunk, as well as making recommendations for future research and innovation.

This second iteration of STRIDE is an evidence-based algorithm for compression selection, extended to cover the upper limb, trunk and breast. The STRIDE algorithm is patient-centred and complexity-informed, encompassing the site, shape and size of oedematous swelling; impact of tissue texture on textile types; 24-hour refill patterns; patient-specific issues; pressure dosage among other textile characteristics; and oedema etiology and staging. This article details the elements of the STRIDE algorithm and presents practical tools for its application.

Objective: Diabetic foot ulcers (DFUs) are a severe complication of diabetes, contributing significantly to patient morbidity, healthcare costs and amputations. Current treatment approaches often fall short in addressing the challenges posed by hard-to-heal (chronic) wounds. This study evaluates the efficacy of autologous whole blood clot (AWBC) therapy in treating hard-to-heal DFUs.

Method: Patients with hard-to-heal DFUs who were unresponsive to previous treatments were included in this case series. Prior to AWBC application, the wounds underwent debridement and cleansing of the wound bed. For the treatment, 18ml of blood was drawn from the patients to create the clot placed on the wound. Patients were evaluated weekly for wound healing progress.

Results: AWBC treatment was initiated in 20 patients, resulting in an average wound size reduction of 59% (p<0.001). The mean number of applications per patient was 5.3±1.5. Adverse events included contact dermatitis in one patient and discontinuation by another due to slower-than-expected healing.

Conclusion: The results of this case series underscore AWBC's potential to restore the wound healing cascade by mimicking the extracellular matrix and promoting re-epithelialisation, angiogenesis and macrophage phenotype transition. AWBC represents a promising, cost-effective solution for DFU management, particularly in patients with complex comorbidities.

Objective: Management of complex hard-to-heal (chronic) wounds presents a substantial challenge in various healthcare settings where logistical constraints and patient-related factors can impede wound closure. This retrospective study evaluates outcomes associated with the use of a dehydrated, full-thickness placental allograft (CompleteFT; ExtremityCare, LLC, US) composed of the amnion, chorion and intermediate layers, when applied to complex hard-to-heal wounds in a mobile care environment.

Method: A retrospective analysis reviewed data collected between February 2024 and July 2025 from patients (aged ≥18 years) with complex hard-to-heal wounds. Data were retrieved from a single mobile wound care service provider team (Compassionate Care Concierge, US). Prior to allograft application, all wounds exhibited stalled healing for at least 30 days with standard of care (SoC). The allograft was applied to all wounds as an adjunct to SoC. Trend changes in wound surface area and percentage area reduction (PAR) across various wound aetiologies were assessed, with additional endpoints including the number of allograft applications and relevant patient parameters.

Results: The patient cohort (n=114, with a total of 184 hard-to-heal wounds), included 51 males and 63 females, with a mean age of 73.1 years. Analysis revealed statistically significant PAR values for various wound aetiologies, such that: p<0.0001 for diabetic foot ulcers (n=11); venous leg ulcers (n=48); pressure ulcers (n=73); and wounds classified as 'other' (n=39). Surgical wounds (n=13) demonstrated a p<0.0007. The study allograft was well-tolerated, with no adverse events directly attributable to the product.

Conclusion: Application of the full-thickness allograft as an adjunct to SoC presents a promising option for supporting wound size regression in complex, hard-to-heal wounds.

Forecasting indicates that the National Health Service in England may face a workforce shortage of up to 360,000 staff by 2036, reflecting challenges that resonate with wider international concerns. This means that wound care must evolve if it is to remain safe, effective and sustainable. One approach that could help is involving patients and carers more closely in their own wound care as evidence suggests that patients want to feel informed, involved and supported in playing a more active role in their wound care. When combined with the right dressing technology, shared wound care could release up to 3.5 billion hours of nursing time globally by 2030. Although many healthcare practitioners already support aspects of shared care, it has not yet become routine. This article sets out the foundations for how shared wound care can become routine practice. Incorporating evidence from key published studies, insights from a key opinion leaders-led 'Hackathon', and input from a patient focus group, work has been undertaken to shape what shared wound care could look like in real-world clinical practice. Practical ideas from the Hackathon included: a clinician checklist; a simplified wound care diary (with the option of a patient contract); visual explainers to show what shared wound care looks like in practice; and step-by-step guides for the care of different wound types. Feedback from the patient focus group showed that patients want to be empowered. With the right support and materials, such as wound diaries and change indicators, patients can often manage their wound care confidently and safely, positively improving their quality of life.

In the field of wound medicine and surgery significant attention is devoted to well-defined hard-to-heal (chronic) wounds, such as diabetic foot ulcers (DFUs), venous leg ulcers (VLUs) and pressure ulcers (PUs). These conditions dominate research, clinical guidelines and resource allocation, due to their clear aetiologies and high prevalence among specific patient populations. However, a substantial category of wounds-often labelled as 'other' open wounds under International Classification of Diseases (ICD)-10 codes-remain underappreciated and frequently excluded from analyses. These include non-specific open wounds without a particular aetiology, as well as surgical and trauma wounds that persist in outpatient settings without evolving into more specialised diagnoses. This opinion piece-building on the reimbursement framework proposed by Tettelbach et al.-argues that neglecting these 'other' wounds perpetuates inefficiencies in healthcare, exacerbates patient suffering and inflates economic burdens. By integrating comprehensive treatment strategies for all open wounds, regardless of aetiology, we can improve patient outcomes, reduce costs and advance equitable wound care interventions.

Objective: To examine the evidence for the clinical and cost-effectiveness of integrated digital wound management (IDWM) systems.

Method: Using rapid review methodologies a search was conducted for studies evaluating IDWM systems in a healthcare setting. Searches were conducted in six research databases from 2012 up to 29 September 2023. A single reviewer screened all records. Data extraction was checked by a second reviewer.

Results: Searches identified 5100 articles for screening, of which 17 met the inclusion criteria. The findings from the included studies showed that IDWM reliably and accurately measured surface areas, particularly of wounds between 3-10cm² in size; however, wound boundaries required manual adjustment for some wounds. Systems were not accurate for measuring wound depth. Feasibility studies (n=8) found IDWM is feasible, but there were limited comparative outcomes available. IDWM appeared to reduce the time taken to measure wounds in practice. The available evidence did not allow determination of cost-effectiveness.

Conclusion: The results of this analysis showed that IDWM is a promising intervention for wound care; however, more comparative evidence is needed to determine whether it is clinically or cost-effective.

Objective: The application of cold atmospheric plasma (CAP) has been described as a promising therapeutic approach for wound healing. Its use in immunologically mediated wounds such as pyoderma gangrenosum (PG) has not yet been sufficiently investigated. This pilot study aimed to evaluate the efficacy, tolerability, patient preferences, and patient-reported outcomes of CAP in PG.

Method: This monocentric, open-label, randomised and controlled pilot study included patients with PG. The treatment phase lasted 12 weeks, with two CAP treatments per week (for patients in the treatment group (TG), versus patients in the control group (CG) who received standard of care only) and five documented study visits. Effects on wound status and patient experience-including pain reduction, improvement in quality of life, and perceived treatment benefit-were assessed.

Results: Both the TG and the CG comprised 10 patients each. In the TG, a statistically significant reduction in fibrin coatings was observed between Visit 1 and Visit 5 (z=-2.060; p<0.025; n=6; d=0.84). While not statistically significant under the predefined threshold (a=0.025), necrosis showed a trend toward reduction (p=0.039). A significant reduction in pain was also observed between Visit 1 and Visit 5 in the TG (z=-2.03; p<0.025; n=5; d=0.91).

Conclusion: The results of this pilot study suggest that CAP is a safe and well tolerated treatment option for PG, and may reduce wound pain over the course of treatment. There is evidence that CAP may have a beneficial effect on the status of the wound in PG. Double-blinded randomised controlled trials, including larger cohorts and outcome-oriented randomisation, are needed to further clarify the therapeutic potential of CAP in PG.