Journal of wound care最新文献

Until recently, autologous punch grafting was reported for the treatment of vitiligo and other skin diseases such as nevus depigmentosus, piebaldism and postinflammatory or chemical leukoderma, as well as for ulcers and leg lesions. However, no studies have investigated its use in managing complications arising from necrotising fasciitis, to the best of the authors' knowledge. Given the nature of this bacterial infection-which affects the full thickness of the skin in the lower limbs-the favourable results achieved with punch grafting in ulcers suggest promise for its application in necrotising fasciitis as well. The authors present the case of an older male patient with necrotising fasciitis on the left leg, treated with autologous punch grafting. His medical history included obliterative arteriopathy, type II diabetes, and orthotopic heart transplantation under immunosuppressive therapy. He was hospitalised for cellulitis with tissue necrosis. After antibiotic therapy and surgical debridement, he was treated with autologous punch grafting from April to October 2021. By the end of treatment, complete restoration of skin integrity was achieved. In conclusion, autologous punch grafting may represent a valuable alternative for treating extensive ulcerations caused by necrotising fasciitis-particularly in immunocompromised patients-given its technical simplicity and the resulting improvement in quality of life.

Objective: Antimicrobial resistance (AMR) poses a significant global health threat, particularly in wound care, where non-healing wounds often harbour pathogens that complicate healing and reduce treatment efficacy. Despite available guidance, antimicrobial use remains inconsistent and often lacks alignment with antimicrobial stewardship (AMS) principles. This study aimed to assess global practices in, and awareness of, infection prevention, management and AMS in wound care.

Method: A cross-sectional survey was distributed to a global database of more than 66,000 healthcare professionals. A total of 712 responses were collected between August and September 2025. The survey contained 27 questions, exploring infection management, the use of antiseptic cleansing solutions, topical and systemic antimicrobial use and AMS implementation from across a wide range of healthcare professions globally, with a focus on wound care.

Results: Participants represented diverse clinical roles and settings, with most identifying as specialist wound nurses. While 59.4% followed formal infection protocols, 37.2% reported not following AMS guidelines. Antimicrobial dressings such as silver, iodine, polyhexamethylene biguanide, chlorhexidine gluconate and honey were reported to be used by 88.2% of participants, with 41% reporting 'just in case' use of antimicrobial dressings. Antiseptic cleansers were also widely used. AMS leadership structures varied. Key support needs for decision-making included clinical evidence (77.9%), treatment pathways (71.6%) and guideline development (71.6%).

Conclusion: Findings highlight both strengths and gaps in infection prevention, management and AMS implementation. High use of antimicrobial dressings in general and as a precautionary measure may indicate a lack of adherence to AMS principles. The lack of consistency in AMS leadership reported within clinical settings may indicate a variation in protocols and practice across wound care. Greater integration of evidence-based guidance, education and leadership as part of wider AMS structures and teams are needed to support consistent antimicrobial use and mitigate AMR in wound care.

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.