Journal of wound care最新文献

Objective: Deep sternal wound infection (DSWI) is a rare but devastating complication that is estimated to occur in 1-2% of patients after median sternotomy. Current standard of care (SoC) comprises antibiotics, debridement and negative pressure wound therapy (NPWT). Hyperbaric oxygen therapy (HBOT) appears to be an effective adjuvant therapy for osteomyelitis. The aim of this study was to determine the effectiveness of HBOT and real-time fluorescence imaging (RTFI) in a DSWI treatment protocol and their benefits on infection control.

Method: A retrospective analysis of DSWI management was performed. Enrolled patients were divided into two groups: HBOT group and RTFI group. Patients in the HBOT group received SoC, HBOT, NPWT and reconstructive flap surgery. Patients in the RTFI group received the same therapeutic plan as well as treatment with a RTFI device (MolecuLight i:X (MolecuLight, Inc., Canada) to achieve high-quality debridement. Infection status and short-term outcomes within three months were measured. Long-term outcomes were analysed at a 12-month follow-up.

Results: Of the 55 patients enrolled: 22 in the HBOT group and 33 in the RTFI group. Infection control status, evaluated in terms of white blood cell counts and C-reactive protein levels, antibiotic use duration, antibiotic costs, reinfection rate and osteomyelitis recurrence rate, were statistically significantly improved in the RTFI group (<0.001, <0.001, 0.042, 0.022, 0.049 and 0.022, respectively). Length of total intensive care unit stay and duration of complete healing were statistically significantly decreased in the RTFI group (<0.001 and 0.046, respectively).

Conclusion: Patients with DSWI can benefit from HBOT, especially in terms of in-hospital mortality. RTFI can be used to eliminate bacterial burden and achieve high-quality debridement, which considerably improves infection control and clinical outcomes.

Objective: There is little use of maggot debridement therapy (MDT) worldwide, albeit there is much literature supporting its benefits and effectiveness for hard-to-heal (chronic) wounds. Hard-to-heal wounds are becoming ever more prevalent and MDT can play a pivotal role in wound care management. This underuse can be associated with patients' perceptions and experiences of MDT. The aim of this study was to synthesise available evidence exploring the perceptions and experiences of patients with hard-to-heal wounds regarding MDT.

Method: This was a systematic review of qualitative evidence using thematic synthesis. Published papers and grey literature from inception until December 2021 were identified from PubMed, Embase, Cochrane, CINAHL, PsycINFO, ProQuest Social Science Premium Collection, Academic Search Complete, Web of Science, WorldWideScience.org, MedNar and Scopus. The screening process, assessment of methodological quality, and data extraction were conducted by two independent reviewers. Papers included had qualitative designs, such as phenomenology and descriptive-exploratory. Mixed methods papers and case reports were included for their qualitative components. Eligible papers were appraised using checklists from the Joanna Briggs Institute for qualitative research and case reports. Data were extracted using a standardised form. Findings were synthesised using Thomas and Harden's thematic synthesis approach.

Results: A total of six papers exploring patients' (n=67) perceptions and experiences regarding MDT were included. Some 52 findings were grouped into 11 categories, generating three synthesised findings: the complexity of living with a hard-to-heal wound and seeking help; the effects of interpersonal relationships; and the relationship between the individual and the larvae.

Conclusion: Findings of the review showed that health professionals are key drivers in encouraging patients' acceptance of MDT and enhancing their treatment experiences. Together with a patient-centric approach, patients' concerns can be effectively addressed. Public and patient education can be beneficial to address misconceptions regarding the therapy.

Sweet syndrome (SS), which is characterised by fever and erythematous tender skin lesions, has been shown to be associated with lymphoma. However, there are limited reported experiences on the wound care of SS in patients with lymphoma. This case report presents the wound care of SS in a patient with anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALK+ALCL). A 42-year-old male was referred to the The First Affiliated Hospital of Guangzhou University of Chinese Medicine Hospital with redness and pain in the left shoulder and abdomen following chemotherapy for ALK+ALCL in early 2021. Physical examination found lesions in the abdomen and shoulder. The lesions were ruptured on day 5 and found to be composed of necrotic tissues. After debridement, the wounds were successively treated with silver ion antibacterial dressing, Mepilex Border Lite (Mölnlycke Health Care, Sweden), silver sulfadiazine gauze, Shengji ointment (a traditional Chinese therapy), UrgoTül (Urgo Medical, France), and fire needling therapy (another traditional Chinese therapy). At three months later, the wound in the abdomen was healed, but the shoulder wound was still unhealed. Based on the physiological manifestations and current treatment process, the patient was diagnosed with SS after multidisciplinary consultation. Prednisone tablets were then administered and the shoulder wound completely healed after two months.

Hard-to-heal (chronic) wounds are a challenge to wound care professionals, a burden to the health service and negatively impact affected individuals' quality of life. They also consume a great deal of healthcare resources globally and are found in all settings, including prisons. Therefore, the evaluation of wound care services is essential in order to develop an awareness of where improvement can be made. The main aim of this point prevalence study was to gather data on wounds, wound aetiology and wound management in a Maltese correctional facility. A secondary aim was to compare current practice with the best evidence-based practice and clinical practice guidelines, in order to provide a set of recommendations which can be implemented to improve the service. A retrospective study was carried out, auditing the medical records of people with justice involvement. The results of the audit reported a low prevalence of wounds. While practice met existing standards, for example, no unnecessary wound swab was taken, several shortcomings in wound management were noted. To improve adherence to the clinical guidelines in conjunction with improving the quality of the current service offered in the wound clinic, a number of short- and long-term clinical recommendations were proposed including: the incorporation of pain assessment tools and C-reactive protein blood testing for identifying infection; early referral to specialised care for individuals with diabetic foot ulcers, as well as the necessity for proficient personnel specialising in wound management training.

Objective: Diabetic foot ulcer (DFU) is a common complication in patients with diabetes. With current treatment, only two-thirds of patients heal, with a median duration of 3-6 months. Hard-to-heal DFUs are a major source of morbidity and mortality. Improving wound healing via soft tissue reconstruction may be the key to improving clinical outcomes. Thus, the Diabetic Limb Salvage (DLS) service in Sengkang General Hospital, Singapore, was established to provide patients with a streamlined, one-stop, comprehensive service dedicated to DFU soft tissue reconstruction. The reconstruction was carried out using secondary closure, skin grafting, local flaps or free flaps, depending on the severity of the wound and patient suitability. This study aims to audit the early outcomes of the DLS service.

Method: Patients with DFUs treated by the DLS service were compared with patients with DFUs treated prior to the launch of the DLS service (control). Outcomes including major and minor amputation rates, wound healing rate, mortality and DFU recurrence rates were analysed statistically.

Results: A total of 103 patients took part in the study (50 in the DLS service cohort and 53 in the control cohort). There was no significant difference in demographics, comorbidities and wound profiles between the two cohorts. All (100%) patients in the DLS service cohort received soft tissue reconstruction versus only 13% in the control group. The DLS service cohort had a significantly higher healing rate (96% versus 68%, respectively), shorter healing duration (77±30 days versus 111±43 days, respectively), reduced major amputation rate (0% versus 9%, respectively), and reduced recurrence rate (6% versus 25%, respectively) compared with the control cohort within the one-year follow-up.

Conclusion: The findings of this study showed that an orthoplastic multidisciplinary approach focused on DFU soft tissue reconstruction improved wound healing rates, shortened healing duration and, as a result, lowered amputation rates and reduced recurrence.

Objective: Burns to the hand are a common injury in paediatrics and can be traumatic to children, both physically and psychologically. Timely conservative or operative management is critical to maximise healing and minimise long-term complications in these young patients. Here, we present the cases of patients treated with a novel skin substitute formed into a prefabricated glove. The glove (PermeaDerm, Inc., US) is a bioactive matrix composed of a silicone composite membrane embedded with collagen and aloe extract with variable porosity that allows moisture to pass to a secondary dressing. To our knowledge, our group was the first to treat a small set of paediatric patients with hand burns with the glove.

Method: A chart review was conducted to analyse hospital course, treatment length, complications and outcomes for each patient.

Results: The age range of the five patients included in this case series was seven months to three years. All five patients had scald burns to the hand. Overall, healing with the glove was successful, with little scarring or altered skin pigmentation, and a full range of motion at the affected joints.

Conclusion: Hand burns in paediatric patients are traumatic and cumbersome to the patient and their families. This bioactive matrix glove allows for a one-time application, decreases operating room time and need, and reduces the demand for multiple dressing changes. In our set of five patients, the glove showed promising results as a safe and effective noninvasive treatment option for hand burns in paediatric patients.

Objective: Negative pressure wound therapy (NPWT) and hyperbaric oxygen therapy (HBOT) have been widely used in the treatment of hard-to-heal (chronic) wounds, but there is still a lack of sufficient evidence for their combined use for the treatment of hard-to-heal wounds. This systematic review aimed to identify the clinical efficacy and safety of adding adjunctive HBOT to NPWT for hard-to-heal wounds.

Method: Embase, PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure and Wanfang were searched from the establishment of the database to March 2022. The literature was screened according to the inclusion criteria and exclusion criteria. We assessed the quality of each included study with the Cochrane Collaboration Risk of Bias tool and Newcastle-Ottawa Scale. A meta-analysis was performed using R programming software version 4.1.0 (R Project for Statistical Computing, US). The PRISMA 2020 guidelines were used to report data from systematic reviews and meta-analysis.

Results: A total of 15 studies were identified, including nine randomised clinical controlled trials and six retrospective studies. Meta-analysis results showed that NPWT combined with HBOT had better outcomes compared with the NPWT alone with regards to: wound healing rate (odds ratio (OR)=6.77; 95% confidence interval (Cl): 3.53-12.98; p<0.0001); bacterial positive rate of wound (OR=0.16; 95% CI: 0.05-0.55; p=0.0037); wound healing time (mean difference (MD)= -3.86; 95% Cl: -5.18 - -2.53; p<0.0001); wound area (standardised mean difference (SMD)=1.50; 95% Cl: 0.35-2.65; p=0.0104); hospitalisation time (MD= -3.14; 95% Cl: -4.93 - -1.36; p=0.005); and hospitalisation cost (OR= -202.64; 95% Cl: -404.53 - -0.75; p=0.0492). There was no significant difference in pain score (MD= -0.43; 95% Cl: -1.15-0.30; p=0.25).

Conclusion: The findings of this study demonstrated that adjunctive HBOT with NPWT is safe and effective in the treatment of hard-to-heal wounds. However, these findings should be interpreted with great caution given the limitations of the studies included.