Journal of wound care最新文献

Objective: Epidermolysis bullosa (EB) is a group of skin disorders leading to blister formation and impaired wound healing. Here we present the case of a patient with EB who underwent successful full-thickness Meek skin grafting for the reconstruction of a wide local excision of a cutaneous squamous cell carcinoma. The modified Meek technique is a method of cutting and separating squares of skin graft to obtain a greater expansion ratio than traditional meshed skin grafts.

Method: A dermal substitute was used to close the wound in stages, to allow histological clearance before definitive wound closure. The expansion ratio obtained using the modified Meek technique allowed a relatively small donor site skin graft to be used.

Results: The use of a full-thickness skin graft (FTSG) avoided the need for wound closure by re-epithelialisation. This allowed graft donor site morbidity to be minimised.

Conclusion: We believe this is the first documented use of the Meek technique in patients with EB, as well as the first use of the Meek technique in conjunction with a FTSG. The combination of a dermal substitute along with the full-thickness Meek skin grafting technique allowed successful and stable reconstruction of a large wound with a minimal donor site, avoiding amputation in this patient. This case demonstrates the potential of this method in this subgroup of patients with impaired wound healing and often limited suitable donor sites.

Objective: Diabetes frequently results in diabetic foot ulcers (DFUs), which can lead to lower limb amputation if left untreated. Current DFU management consists of a multidisciplinary team approach, including physicians, podiatrists, wound care specialists, nursing staff and patients. Traditional diagnoses of DFUs can be expensive, lengthy, and generally reliant on local and private clinical evaluation. There is a need for an automated, remote, diagnostic option for patients with suspected DFUs.

Method: This paper introduces MGWONET, a new model for deep learning (DL) on classification problems, using the Modified Grey Wolf Optimisation (MGWO) algorithm to automatically find the optimal configuration of hyperparameters. The automation settings are intended to govern the model's operation, and include the number of layers, learning rate and filter sizes. To improve the accuracy and efficiency of DL models, it is essential to carefully select the right hyperparameters. However, choosing the best combination involves searching through a large number of possible settings, which is computationally challenging and complex. Unlike manual tuning, which is time-consuming and inefficient, the MGWO algorithm efficiently explores the large and complex hyperparameter search space to improve the model's accuracy and robustness. MGWONET is intended for classifying skin patches as healthy or ulcerated, and was trained with an augmented dataset of 2200 DFU images. Generally recognised metrics, such as accuracy, recall, precision, specificity, balanced classification rate and the receiver operating characteristic curve were used to evaluate optimal model performance.

Results: The optimal model had a classification accuracy equating to 98.64% and was superior to a selection of well-known DL architectures: AlexNet; VGG16; GoogLeNet; and a monochrome baseline Grey Wolf optimised model. This study is centred on binary image-based classification and does not constitute a clinical grading system; however, the method presented here has the potential to be a valuable supportive addition to clinical practice.

Conclusion: The MGWONET framework has proved to be highly reliable and provides robust discriminative power, making it a strong candidate for automated DFU diagnosis. It has a potential role in supporting clinicians, reducing diagnostic burdens, and accessing early urgent interventions through smart health services.

Objective: To evaluate the preventative effects of integrated operating room-central sterile supply department (OR-CSSD) instrument management combined with enhanced perioperative nursing care on surgical site infections (SSIs) in abdominal surgery.

Method: In this prospective, controlled study, patients undergoing abdominal surgery between January and October 2024 were randomly assigned to either a control group receiving standard instrument and nursing care, or an intervention group receiving integrated OR-CSSD instrument management and enhanced perioperative nursing interventions. Key outcomes included SSI incidence within 14 postoperative days, operative time, postoperative white blood cell (WBC) count, length of hospital stay, instrument quality control scores, and nursing safety quality scores.

Results: The experimental cohort comprised 148 patients. The intervention group (n=70) demonstrated significantly lower SSI rates (1.4% versus 10.3%, p=0.035), reduced operative time, decreased WBC count on postoperative day 2, and shorter hospital stays compared with the control group (n=78; all p<0.05). Additionally, the intervention group achieved higher scores in both instrument quality control and nursing safety assessments, particularly in environmental management and equipment handling domains.

Conclusion: In this study, the integration of OR-CSSD instrument management with enhanced perioperative nursing care significantly reduced SSI rates in abdominal surgery, improved postoperative inflammatory markers, shortened operative and hospitalisation durations, and enhanced the overall quality and safety of surgical care.

Objective: Strategies for preventing continuous electroencephalography (CEEG)-induced pressure injuries (PIs) are scarce. This study aimed to investigate the effect of the placement of polyurethane foam between the electrodes on the frontal forehead and on the back of the head in preventing CEEG-induced PIs in paediatric patients.

Method: Patients aged <18 years who underwent CEEG overnight, between 1 April 2020 and 31 December 2021, were included in this retrospective study. Patients were divided into non-polyurethane and polyurethane groups based on the method of electrode attachment. An additional procedure was performed in the polyurethane group; a 5mm thick polyurethane foam and silicone-faced wound dressing mesh were attached between the electrodes on the frontal forehead, and a 4cm thick piece of polyurethane foam was placed on the back of the head for patients unable to change their head position. The primary outcome was the injury prevention rate in the polyurethane group.

Results: A total of 77 patients were included in the non-polyurethane group and 65 patients were included in the polyurethane group. The incidence of PIs was 1 (1.5%) and 5 (6.5%) in the polyurethane and non-polyurethane groups, respectively. The PI prevention rate in the polyurethane group was 77%.

Conclusion: In this study, the method of placing polyurethane foam during CEEG prevented CEEG-induced PIs. The method can be easily implemented in various facilities owing to its simple and inexpensive nature.

Objective: Hard-to-heal (chronic) stage 3 pressure injuries (PIs) in medically complex patients are often refractory to standard treatments, and pose significant risks of infection, limb loss and diminished quality of life. Adjunctive use of advanced biologic materials, such as bovine-derived collagen matrices, may support more efficient wound resolution in these high-risk populations.

Method: In this retrospective case series, patients with hard-to-heal stage 3 PIs of the lower extremity were treated with a single application of a bovine-derived collagen matrix as part of a multidisciplinary wound care protocol. All patients had significant comorbidities, including diabetes and dementia, as well as mobility impairments, such as peripheral neuropathy and multiple sclerosis with paraplegia. Interventions included debridement, a single application of a bovine-derived collagen matrix, appropriate wound dressings and pressure offloading.

Results: All three patients (each with one PI) had failed to respond to prior standard wound care and their PIs had persisted from four weeks to approximately three years before treatment. Following a single application of the collagen matrix, complete wound closure was achieved within 27-52 days. Early wound responses were notable: one PI showed a 98% area reduction by day 14, another reduced by 76% by day 6, and in Case 2, closed by primary intention, stable closure was observed as early as day 3. No repeat applications of the bovine-derived collagen matrix were required, and no complications or recurrences were observed at follow-up.

Conclusion: This case series highlights the potential of bovine-derived collagen matrix as an effective adjunct to comprehensive wound care in medically complex patients with stage 3 PIs that have persisted for several months to years, despite prior standard treatments. In all cases, complete wound closure was achieved following a single application of collagen matrix, highlighting its potential utility in the management of hard-to-heal PIs. Further prospective studies are warranted to validate these outcomes.

Objective: Pressure injuries (PIs) remain a significant challenge in both hospital and community-based care in Norway. Despite being largely preventable, their prevalence remains high, with serious consequences for patients, caregivers and the healthcare system. Our digital wound projects have explored the lived experiences, systemic burden, and innovative responses to PI prevention and care, drawing from both quantitative data and qualitative insights.

Method: This mixed-methods study combined Norwegian prevalence data with thematic analysis of semi-structured interviews conducted with patients, relatives and district nurses. The qualitative data focused on the experience of patients living with or managing PI, with particular attention to continuity, competence and the role of digital innovation in wound care. A focus group interview with healthcare professionals (HCPs) and a manager discussed implementation barriers to digital innovation.

Results: Patients described reduced quality of life due to isolation, and lack of consistent care. Caregivers reported a need for support from wound care specialists. HCPs highlighted challenges including the need for a cooperative financial model to cover increased costs in the municipalities, limited resources, training gaps and fragmented communication across care levels. Digital wound care was positively received, and improved access to the healthcare service, continuity in the service, and patient safety, despite occasional technical issues. However, the current reimbursement model poses financial challenges towards the municipalities.

Conclusion: PIs remain a significant clinical and systemic burden in Norway. While digital solutions and national safety initiatives show promise, sustainable improvement requires investment in training, leadership and cross-sector coordination. Patients and nurses emphasised that relational continuity and accessible specialist knowledge were critical to effective PI prevention. This project supports a shift toward integrated, patient-centred wound care models that blend digital innovation with local competence and continuity across care levels. However, the misalignment in costs hinders widespread implementation and perpetuates reliance.