Journal of wound care最新文献

Nitric oxide (NO) is one of the most studied molecules in medical science. The role of NO as an endogenous regulator of inflammation, as an antibacterial agent and as an endogenous gasotransmitter is well established. Even so, despite a plethora of excellent wound healing data, hard-to-heal (chronic) wounds are of epidemic proportions, and still growing in number. However, yet to be established and sorely needed is the identification of a single, continuous NO mechanism of action (MoA), where phase-to-phase variance in the complex sequence of cellular and molecular wound healing may elucidate the potential for placing hard-to-heal wounds on positive healing trajectories. Hence, the objectives of this review were to: identify salient MoAs for NO in each phase of skin wound healing; and to select and validate a single MoA that is both ubiquitous and continuous in NO across acute and hard-to-heal wound sequences, and which potentiates the ability to supplementally motivate and guide the recovery of a hard-to-heal wound onto a positive healing trajectory. The search began by selecting a detailed, multipart wound healing model. Next, as guided by the literature, was the identification of salient NO functionalities for each model segment. These modes of action were then be used to identify and validate a single NO MoA that is continuous across the healing spectrum. Finally, by using the principle of 'super position' of two continuous functions, this acute healing NO MoA solution was compared to a similar solution set describing a hard-to-heal or chronic wound. As both solution sets are continuous in a NO function, the resultant 'overlay' then helped to identify and guide the use of a NO MoA capable of placing any hard-to-heal wound on a positive healing trajectory.

Objective: The most common severe exfoliative condition is toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, for which patients may sometimes require admission to hospital burns units. This study analyses the experience of the authors and results in this condition at the Cruces University Hospital in Bilbao, Spain.

Method: Over the last 22 years, the authors carried out a retrospective analytical observational study of TEN cases at the hospital and analysed risk factors including age, associated comorbidities, percentage of body surface area affected, positive bacterial culture, and treatment strategies used to assess their potential influence on prognosis.

Results: The results indicated an association between mortality and age (ρ (rho)=0.60, 95% CI [0.29, 0.79], p<0,001), ocular (ρ=0.58, 95% CI [0.28, 0.78], p<0.001), oropharyngeal (ρ=0.64, 95% CI [0.36, 0.81], p<0.001), genitourinary (ρ=0.58 CI [0.28, 0.78], p<0.001) respiratory mucosa involvement (ρ=0.53, 95 % CI [0.28, 0.78], p<0.001) and bacteraemia (ρ=0.44, 95% CI [0.17, 0.64], p=0.020). Bacteraemia also showed a higher incidence in elderly patients (ρ=0.4, 95% CI [0.03, 0.67], p=0.033) and in those with a higher Score for Toxic Epidermal Necrolysis at admission (ρ=0.51, CI [0.17, 0.74], p=0.006). A reduction in mortality was found in patients who received systemic treatment; cyclosporine, etanercept or a combination of both (ρ=-0.44, Cl [-0.70, -0.09], p=0.018).

Conclusion: TEN is a rare but serious exfoliative condition. Traditionally, management of denuded skin was seen as the main prognostic factor; yet, systemic damage, especially to the respiratory mucosa, significantly increases mortality risk. While life support is crucial and recovery is possible, preventing long-term sequelae relies on effective care protocols. Current treatments may offer benefits, though their efficacy remains unclear. Clinicians in burns units should develop standardised protocols and collaborate on long-term studies to enhance patient care.

Wound healing is a series of complex and dynamic processes which occur in several stages. Optimal wound healing is essential for restoring the integrity and function of the affected area. Although medicated wound dressings have been extensively employed to control wound infection, the risks associated with antimicrobials make the use of non-medicated alternatives necessary. Nevertheless, the relationship between the concentrations of medicated wound dressings and their antimicrobial activities, along with their wound healing efficacies, still remains unclear. Non-medicated wound dressings are an alternative to dressings that contain active ingredients acting as antimicrobials or antiseptics. In the present study, the researchers examined the reduction of bacterial load as the primary endpoint and the healing rate as the secondary endpoint, comparing microporous ceramic dressings to silver-impregnated dressings in participants from two outpatient wound management clinics. The study included 25 participants in the silver-impregnated dressing (control) group and 28 participants in the ceramic dressing (study) group. The participants' wounds were assessed through MolecuLight i:X (MolecuLight Inc., Canada) wound tracing and MolecuLight i:X fluorescence imaging to measure the wound size, as well as presence of a bacterial load of >10⁴ colony forming units/g at weeks 1, 2, 3 and 4. The results indicated that there was a significant difference in the distribution over the categories of bacterial load cleared after weeks 1, 2, 3 or 4 in the two groups. Moreover, the bacterial load cleared significantly faster in the study group (p=0.001). Mean wound size was 10.93cm² (range: 0.10-37.95cm²) in the control group and 11.48cm² (range: 0.80-60cm²) in the study group. In the maximum likelihood regression analysis, the mean reduction in wound area for the study group was greater than that for the control group. The study concluded that the ceramic dressings could be an effective alternative to silver-impregnated dressings when treating infected wounds.

Frostbite, defined as tissue freezing due to cold weather exposure, is a major risk associated with mountaineering in cold climates. It represents a significant source of morbidity in the climbing population. In 2021, three individuals were evaluated at a single institution after developing frostbite while climbing Denali, Alaska, US. The affected patients were healthy men in the third to sixth decade of their lives, and all experienced frostbite injuries involving the fingers. Among the patients, one individual was unable to descend from the mountain due to the severity of his condition and required medical evacuation. The other men were able to descend without significant difficulty. After leaving the mountain, the patients were treated with thrombolysis, pentoxifylline, hyperbaric oxygen therapy, and/or regional sympathetic blockade. Exposure to cold weather, ascent to high altitudes, and increased mechanisms of heat loss were likely potential risk factors for frostbite injury in these patients. Psychological factors related to the COVID-19 pandemic may have also impacted these individuals' risk for frostbite injury. Prevention is the most effective way to avoid frostbite, and knowledge and understanding of the risks associated with the development of this condition may reduce future occurrences among mountaineers. Since frostbite is not a common diagnosis encountered in patients treated in outpatient wound centres, physicians should maintain awareness of the pathophysiology and treatment options for this condition.

Objective: Studies have suggested that ozone therapy stimulates antioxidant enzyme expression and activity, regulates growth factor production, increases local blood flow and provides antibacterial protection. We sought to analyse the evidence related to the use of ozone therapy in the treatment of diabetic foot ulcers (DFUs).

Method: A systematic review and meta-analysis was conducted using published clinical trials indexed in the PubMed, Embase and Web of Science databases up to December 2020. Outcomes analysed included: number of ulcers cured; ulcer area reduction; length of hospital stay; changes in blood glucose levels; antioxidant activity; and number of amputations.

Results: Initially, 61 studies were identified; however, only six met all of the eligibility criteria for inclusion in the final sample. It was found that patients receiving ozone therapy displayed higher rates of healing (i.e., healed ulcers), shorter hospital stays, increased catalase activity and reduced blood glucose levels. There was an observed increase in the number of ulcers healed; however, there was a considerable risk of bias in the studies evaluated.

Conclusion: Although many studies have suggested ozone therapy as a promising candidate in the treatment of DFUs, further research is required, with a better scientific outline, to validate the results.

Objective: The aim of this study was to observe the surgical wound healing process in patients with multiple myeloma who had undergone surgery.

Method: We collected clinical data on patients with multiple myeloma and observed wound healing following surgical therapy. Additionally, we compared the expression of angiogenesis markers in patients with and without multiple myeloma (undergoing surgical excision of other tumour tissues). In patients who had multiple myeloma bone disease, we examined several clinical features: haemoglobin levels; albumin levels; blood glucose levels; and surgery programme. We then compared expression levels of the angiogenesis markers CD31, CD34 and vascular endothelial growth factor (VEGF) in samples scraped from the skin margin of the surgical incision in 12 patients without multiple myeloma (control) and nine patients with multiple myeloma.

Results: All 61 patients with multiple myeloma observed showed no disunion, no delayed union and no infection in their wound healing. CD31 and VEGF expression was higher in the nine patients with multiple myeloma compared with the 12 control patients without. We observed no difference in CD34 expression between control and experimental groups.

Conclusion: The results of this study suggest that patients with multiple myeloma who have undergone surgery recover well and produce higher quantities of new vessels compared with patients without multiple myeloma. This occurs through increased expression of CD31 and VEGF, angiogenic factors which promote wound healing. We did not observe higher expression of these factors contributing to increased incisional implantation metastasis.