Journal of wound care最新文献

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.

Objective: Lower extremity hard-to-heal wounds affect >2.4 million people in the US and are characterised by excessive inflammation. One potential management technique is the use of placental-derived allografts, which contain an extracellular matrix scaffold and key regulatory proteins. The aim of this study was to compare, using wound closure analyses, the clinical outcomes of patients using a hypothermically stored amniotic membrane (HSAM) allograft as a protective barrier, which retains the structure and content of native amnion for supporting healing of lower extremity open wounds via intact or meshed techniques.

Method: A retrospective chart review identified adult patients from January 2017-October 2018 who had received HSAM for lower extremity open wounds. Application of HSAM included either an intact or a meshed technique for graft application. Baseline patient demographics were collected, along with wound parameters from baseline until wound closure.

Results: The experimental cohort comprised 13 patients with an average starting wound size of 12.5cm² and who received an average of 5.5 applications of HSAM. Kaplan-Meier survival analysis revealed a median wound closure time of 63 days for the combined cohort, with 48 days and 63 days for intact and meshed techniques, respectively. Wound closure incidence showed that seven patients achieved 100% wound closure; the technique used did not affect closure incidence.

Conclusion: The findings of this study provide evidence that supports further examination of HSAM as a protective barrier for the management of lower extremity hard-to-heal wounds.

Objective: To assess the effects of the UrgoKTwo (Laboratoires URGO, France) compression system on the leg volume, interface pressures, static stiffness index (SSI), comfort and slippage in a very hot environment.

Method: Volunteers from among hospital staff in the Diabetic Foot Center (Cairo, Egypt), whose work involved standing for long periods, and who presented with a pitting oedema, were included in this study. The parameters were assessed at baseline, after four hours of wearing the compression system (T+4h), and following a treadmill test. Leg volume was assessed using HandySCAN 3D Laser (Creaform, Canada).

Results: A total of 20 volunteers took part. The compression system was applied with an interface pressure of 45±3mmHg at baseline. After four hours of wearing the compression system, there was a significant reduction in mean leg volume of 81ml, which represented 2.9% of the mean volume (p<0.001). The SSI calculated at inclusion after bandage application (13±4.8mmHg) increased significantly at T+4h (15.9±4.9mmHg) (p<0.001). This was due to a decrease in resting pressure to 30mmHg without notable slippage. Despite the hot environment, the compression system remained very comfortable to study participants (mean visual analogue scale score: 8±1.6).

Conclusion: The findings of this clinical trial showed that the compression system helped reduce oedema in a very hot environment from the initial hours of wear. The SSI, which increased over the course of the trial, is an essential factor in reinforcing venous haemodynamics of the calf muscle pump.

Objective: The objective of this case series was to assess the clinical outcomes of standard of care (SoC) supplemented with carePATCH (ExtremityCare LLC, US) a dehydrated, dual-layer amniotic membrane allograft, in mediating hard-to-heal wounds that had failed to respond to SoC alone.

Method: Data were collected from electronic health records of patients seen between November 2023 and January 2025 at a single wound care provider group (WelsCare LLC, US). Patients aged ≥18 years with hard-to-heal wounds failing to achieve ≥50% surface area reduction within 30 days of documented SoC treatment were included. carePATCH was applied as an adjunct to SoC following debridement of the wound in accordance with best wound care practices. Changes in wound surface area, percentage area reduction (PAR) and clinical parameters were assessed at baseline, at final application and at one week post final application.

Results: A total of 13 patients (eight male, five female, mean age: 75.1 years) were included. A total of 13 wounds, including venous leg ulcers (n=6), pressure ulcers (n=5), post-surgical wounds (n=1) and venous stasis/arterial wounds (n=1) were evaluated. Median PAR (for all wounds combined) at final application was 77.4%, increasing to 100% at one week post final application. Statistical analysis demonstrated significant improvement in PAR outcomes (p=0.017 at final application; p=0.003 at one week post final application). Box- and-whisker plots revealed consistent surface area reduction across all wound types, with measurements remaining stable one week post final application.

Conclusion: This case series provides encouraging results for the use of carePATCH as an adjunct to SoC in mediating chronic wounds. Patient outcome data support positive clinical experiences with regard to wound regression.

Pressure ulcers (PUs) pose significant challenges in healthcare despite there being evidence-based guidelines for their prevention and treatment. This article examines the impact of guideline implementation on PU incidence, patient quality of life and healthcare costs. Implementation of guideline recommendations, including multifactorial evidence-based interventions and care bundles, have led to a significant reduction in PU incidence and improvement in patient outcomes across diverse healthcare settings. While guidelines offer valuable recommendations, their implementation faces challenges, including healthcare professionals' lack of awareness and knowledge regarding guideline existence and importance. Strategies such as education programmes, and developing guidelines with clear language and easy-to-follow recommendations, are crucial for enhancing guideline uptake. Furthermore, patient and caregiver involvement in PU prevention and treatment is essential for promoting self-care and active participation in care and, in turn, active participation in guideline recommendations. Addressing these challenges through increased awareness, education and patient involvement is vital for improving guideline implementation and patient outcomes with regards to PU prevention and treatment.

Myiasis is a parasitic infection common in tropical areas, such as Brazil. It is caused by infestation of maggots of various fly species in humans. Here, the case of a 38-year-old female patient, with no comorbidities, who was referred to the authors' centre due to a scalp wound infested with larvae and complete soft tissue loss, is presented. A computed tomography scan revealed no evidence of osteomyelitis or intracranial compromise. Since the initial debridement and mechanical removal of the larvae resulted in a large and complex wound, the patient underwent a combined wound approach based on cranial burr holes and negative pressure wound therapy followed by skin graft. The wound revealed excellent skin graft survival, and the patient was safely discharged home. No complications were observed in the follow-up period.

Objective: To evaluate the performance and safety of Biatain Fiber Ag (Coloplast A/S, Denmark), a new gelling fibre wound dressing containing silver, based on percentage of wounds healed in partial-thickness burns within two weeks.

Method: This non-comparative, one-armed, open-labelled, multicentre study, included patients from five different sites in the UK between October 2023 and April 2024. The primary endpoint was whether a wound healed or not. Adverse events were also assessed.

Results: In total, 51 patients with a partial-thickness burn wound that was either infected or at risk of infection, and with medium-to-high levels of exudate, were part of the full analysis set. The proportion of wounds healed within two weeks of treatment was 83.7% (95% confidence interval (CI): 69.3, 93.2) of the 43 patients completing the investigation. In a post hoc sensitivity analysis, assuming that missing data on wound healing were either missing at random or corresponded to a non-healed wound, the estimated proportion of wounds healed was 74.8% (95% CI: 60.7, 85.1). In the pre-planned sensitivity analysis, where all missing data on wound healing were assumed to correspond to a non-healed wound, it was 70.6% (95% CI: 56.2, 82.5). A total of seven adverse events were found related to the investigational device; all were non-serious.

Conclusion: In this study, treatment of partial-thickness burns with the investigational device showed that the percentage of healed wounds within two weeks was comparable to the performance of similar products. In addition, the results revealed no safety concerns. This new gelling fibre wound dressing containing silver may therefore have a notable clinical implication for wound healing in patients with acute wounds that are infected or at risk of infection.