Wound management & prevention最新文献

Background: As COVID-19 has emerged as a pandemic virus, multiple reports have surfaced to describe skin lesions that occur either associated with the virus or due to treatment.

Objective: To compare patient demographics, treatments, and outcomes in COVID-19 symptomatic patients who developed skin lesions (COVID-19 or hospital-acquired pressure ulcer/injury [HAPU/I]) during the first year of the pandemic.

Methods: A retrospective chart review was conducted on COVID-positive symptomatic patients admitted from March 1, 2020, through March 1, 2021. The authors analyzed the difference in patient demographics, patient skin tones, treatments, hospital length of stay (LOS), intensive care unit (ICU) LOS, death, and discharge disposition for those with COVID-19 lesions compared to those who developed HAPU/Is.

Results: Of those who developed lesions, 2.3% developed COVID-19 lesions and 7.2% developed HAPU/Is. Patients with COVID-19 lesions were more likely to be male (64%), younger (median age 60), and had a higher BMI (30) than patients with no wounds and patients with HAPU/I.

Conclusion: This study advances the knowledge of the patient demographics and treatments that may contribute to identifying the new phenomenon of COVID lesions and how they differ from HAPU/Is.

Background: Hyperbaric oxygen therapy (HBOT), in which patients receive high concentrations of oxygen in a pressurized chamber, has been used in clinical practice to improve wound healing. More recent applications of HBOT have resulted in successful management of a wide range of conditions; however, the psychosomatic factors associated with these conditions remain understudied and require clarification.

Purpose: To investigate the effects of HBOT in a female patient without diabetes who presented with an atypical wound of 9 years' duration with no sign of healing as well as with psychosomatic factors.

Case report: The patient underwent 20 once-daily sessions of HBOT for 120 minutes per session every Monday through Friday for 4 weeks at 2.4 ATA (atmosphere absolute pressure) and received daily dressing changes with a nonadherent dressing containing silver, alginate, and carboxymethylcellulose. The 36-Item Short Form Health Survey and the Hospital Anxiety and Depression Scale quality-of-life questionnaires were administered before treatment and after 1 year of treatment. HBOT resulted in complete lasting wound remission as well as subjective improvement in quality of life and in levels of anxiety and depression.

Conclusion: HBOT has known therapeutic effects on wound healing, and it may also have a substantial effect on psychosomatic mechanisms.

Background: Pressure injuries result from prolonged pressure and lead to tissue damage, infections, extended recovery times, and an economic burden.

Purpose: To explore risk factors for pressure injuries in patients who underwent surgery under general anesthesia.

Methods: This retrospective study included patients who underwent surgery at a regional educational hospital in southern Taiwan from January 1, 2018, through December 31, 2018.

Results: A comprehensive multivariate analysis was used to identify the prominent risk factors for pressure injury among the 11 231 patients enrolled in this study. These risk factors were an age of ≥65 years; surgery duration of >120 minutes; diastolic blood pressure of <60 mm Hg for >30 minutes during surgery; intraoperative use of dopamine, norepinephrine, or epinephrine as vasopressors; American Society of Anesthesiologists physical classification of III or higher; minimum intraoperative body temperature of ≤35°C; blood loss of >500 mL; and a supine or prone surgical position.

Conclusions: This study identified several pressure injury risk factors related to surgical conditions and patient characteristics. Surgical teams must monitor, control, and manage these factors, prioritize staff education, and adopt preventive protocols.

Background: Older patients with diabetes have behaviors and practices in foot care that differ from those of younger patients. There is a need for a tool to assess the foot care of patients with diabetes who are over the age of 65 years.

Purpose: This study aimed to assess the validity and reliability of the long and short versions of the Foot Care Scale for Older Diabetics (FCS-OD) in Turkish society.

Methods: A total of 172 older patients with diabetes participated in the study. Language validity, content validity, construct validity, Cronbach's alpha coefficient value, item-scale correlations, parallel form reliability, and test-retest correlations were used to assess the Turkish version of FCS-OD. A patient identification form, FCS-OD, Diabetic Foot Care Self-Efficacy Scale, and Foot Self-Care Behavior Scale were used for data collection.

Results: Turkish versions of the FCS-OD, both short and long versions, were at acceptable levels regarding their content (content validity index: 0.964, 0.975) and construct (factor loadings > 0.4). Both versions of the scale showed a high level of internal consistency as demonstrated by Cronbach's alpha values (short version, 0.802; long version, 0.905) and item-scale correlations (> 0.3). Both versions of the scale were stable over time and compared to the parallel forms.

Conclusions: Both versions of the scale were found to be valid and reliable for Turkish society with regard to psychometric properties.

Background: Chronic wounds include lower extremity ulcers, diabetic foot ulcers, and pressure injuries, and can take months or years to heal. Wounds place a high burden on outpatient and inpatient care settings. This burden is expected to increase markedly in the United States as the population ages and with increased rates of diabetes, obesity, and COVID-19.

Purpose: To articulate the effect of chronic, hard-to-heal wounds on acute care facilities, and how a few days of inpatient care can have a significant effect on the healing trajectory.

Methods: An expert panel of 7 members, all with extensive knowledge and experience in the assessment and treatment of chronic wounds in an acute care setting, was convened in March 2022. The panel discussed the role of hospitals as part of the longer-term healing pathway of chronic wounds.

Results: Chronic wounds have a significant effect on hospitals that includes unseen costs, bed occupancy, demands on bedside nurses, and wound complications that lead to extended stays or readmissions. A successful inpatient wound program offers appropriate identification of previously undiagnosed wounds, elevation of bedside care through simplified protocols, quickly and easily understood education and easy dressing selection, and comprehensive discharge planning with a multidisciplinary team for continuity of care and reduced risk of readmission.

Conclusion: Hospitals can play a key role in the management of chronic wounds, thus reducing the effect on each facility and the wider care network.

Background: Sacral chordoma is a rare, malignant primary bone tumor with subtle clinical manifestations. The extensive cavity and soft tissue defect after radical resection of the tumor can lead to complications such as sacrococcygeal skin necrosis, infection, cerebrospinal fluid (CSF) leakage, and delayed healing or nonhealing.

Purpose: To describe the treatment effect of the combination use of antibiotic-loaded bone cement (ALBC), a gluteus maximus muscle flap, and negative pressure wound therapy (NPWT) on the nonhealing sacrococcygeal wound after sacral chordoma resection.

Case report: A 67-year-old woman with a sacrococcygeal wound following sacral chordoma resection was admitted to the hospital. In the 2-stage surgery, the internal fixation and synthetic dura substitute were exposed and CSF leakage was found after debridement, a gluteus maximus muscle flap was used to cover the synthetic dura substitute to address the CSF leakage, ALBC was used to cover the internal fixation, and a modified NPWT system was fixed to the wound for improved flushing and drainage.

Results: The previously nonhealing wound healed 3 weeks postoperatively, and satisfactory recovery was achieved by 6-month follow-up.

Conclusion: This case report suggests that the combination use of ALBC, gluteus maximus muscle flap, and NPWT can effectively promote sacrococcygeal wound healing after chordoma resection.

Background: Chronic ulcers represent a significant challenge for patients with compromised microcirculation. As a novel branch of research, catalytic nanomedicine has exhibited promising outcomes with the development of nanostructured composites designed to disinfect and improve the healing of chronic wounds through the incorporation of bionanocatalysts within gel matrices.

Purpose: This study aimed to assess the impact of bionanocatalysts on 4 patients suffering from chronic venous ulcers, which had previously been indicated for lower extremity amputation.

Methods: Bionanocatalysts were synthesized and incorporated into a gel matrix. Monthly debridement was conducted with the objective of completely removing nonviable tissue. The bionanocatalyst-embedded gel was applied every other day, covering the entire wound surface and secured with a secondary dressing.

Results: Encouragingly, all cases exhibited complete wound closure, and patients reported no adverse side effects.

Conclusion: These findings offer robust support for the utilization of this technology in wound healing and prompt a reevaluation of the hypothesis regarding the mechanism of action of bionanocatalysts in chronic wounds. Future research endeavors should aim to quantitatively assess the bionanocatalysts' influence on the trajectory of wound healing, as well as address the myriad challenges associated with managing chronic wounds.

Background: The attitudes of nurses should be measured using valid and reliable tools to develop effective nursing care strategies for the prevention of medical device-related pressure injuries and to organize necessary training programs.

Purpose: This study was planned to conduct the Turkish validity and reliability study of the Attitude towards Medical Device-Related Pressure Ulcers/Injuries Questionnaire (MDRPU/I Questionnaire (the English-language version)) in nurses.

Methods: This methodological study included 134 nurses working in hospitals of different sizes and characteristics (public hospitals, training and research hospitals, and university hospitals) in Turkey. The validity and reliability of the Attitude Towards Medical Device-Related Pressure Injuries (MDRPI Questionnaire (the Turkish-language version)) Questionnaire were tested using language validity, content validity, face validity, construct validity, and reliability analyses.

Results: The final version of the questionnaire had a content validity index of 98.03%, sufficient construct validity, and a Cronbach α value of 0.92 for the total questionnaire.

Conclusions: The Turkish version of the MDRPI Questionnaire is valid, reliable, and suitable for measuring the attitudes of nurses in Turkey toward the prevention and care of medical device-related pressure injuries.

Background: Acellular dermal matrices have long been used for complex abdominal wall closure and, more recently, for ostomy reconstruction.

Purpose: To describe ostomy reconstruction with acellular flowable dermal matrix (AFDM) in a pediatric patient with a complex abdominal wall defect.

Case report: A 14-year-old female who was diagnosed with unspecific hemorrhagic colitis at age 6 months and who underwent several abdominal surgeries (including total colectomy and terminal ileostomy) reported frequent, severe periostomy skin ulcerations secondary to improper fitting and ostomy bag leakage due to multiple periostomy skin retraction as a result of multiple abdominal scars. Under sedation, 2 small (5 mm) peristomal skin incisions were made, through which dissection and release of dermal scar tissue was performed. Afterwards, AFDM 40 mL was injected subcutaneously until a uniform, flat surface around the ostomy was achieved. The patient was discharged a few hours postoperatively, after verification of proper fit of the ostomy bag with no leakage. At 18-month follow-up, the patient was very satisfied with the result, with fewer ostomy bag changes and improved quality of life.

Conclusion: This case report indicates that AFDM is a safe and effective minimally invasive technique for ostomy reconstruction, with minimal complications and satisfactory medium-term results.

Background: The management of chronic nonhealing lower extremity wounds remains a problem that substantially affects patients and significantly burdens the health care system. Nonhealing wounds lead to increased hospitalization, decreased quality of life, minor and major amputations, and increased risk of mortality. Dermal matrices have advanced the science of wound healing.

Purpose: To evaluate fetal bovine acellular dermal matrix (FBADM), an acellular dermal collagen repair scaffold derived from fetal bovine dermis, in the management of chronic nonhealing lower extremity wounds.

Methods: A single-center retrospective chart review was conducted to collect data on patients with chronic nonhealing lower extremity wounds treated with FBADM from January 2013 through December 2019.

Results: A total of 43 patients were enrolled, with a mean age of 68.5 years and a mean wound area of 27 cm2. Complete closure of the wound occurred in 53% of patients overall, with 28% of patients achieving healing within 12 weeks.

Conclusion: Application of FBADM in the management of chronic nonhealing lower extremity wounds is safe, effective, and efficient.